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Aesthetic analysis of the ideal eyebrow shape and position

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Abstract and Figures

The aesthetic importance of the eyebrow has been highlighted for centuries. In this paper, we investigated ideal eyebrow. Eyebrows and eyelids, varies among different races, ages and genders. It is considered to be of primary importance in facial expression and beauty. We present one form of the ideal eyebrow aesthetic and discuss methods of optimising surgical results. For the modern acceptable concept of the ideal brow, the medial brow should begin on the same vertical plane as the lateral extent of the ala and the inner canthus and end laterally at an oblique line drawn from the most lateral point of the ala through the lateral canthus. The medial and lateral ends of the brow lie approximately at the same horizontal level. The apex lies on a vertical line directly above the lateral limbus. Individual perceptions and expectations also differ from person to person. The brow should over lie the orbital rim in males and be several millimetres above the rim in female. Male tend to have a heavier, thicker brow with a little arch present. There are some pitfalls in brow aesthetics. Overelevation creates an unnatural, surprised and unintelligent look which is the most common surgical mistake in brow lifting. Medial placement of the brow peak would create an undesired 'surprised' appearance. Moreover, a low medial brow with a high lateral peak induces an angry look. Overresection of the medial brow depressors may lead to widening and elevation of the medial brow, which creates an insensitive look and can also lead to glabellar contour defects. It is impossible to define an ideal eyebrow that is suitable for every face. However, one must consider previously described criteria and other periorbital structures when performing a brow surgery.
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REVIEW ARTICLE
Aesthetic analysis of the ideal eyebrow shape and position
Esin Yalc¸ınkaya Cemal Cingi Hakan So
¨ken
Sec¸kin Ulusoy Nuray Bayar Muluk
Received: 19 August 2014 / Accepted: 19 October 2014
ÓSpringer-Verlag Berlin Heidelberg 2014
Abstract The aesthetic importance of the eyebrow has
been highlighted for centuries. In this paper, we investi-
gated ideal eyebrow. Eyebrows and eyelids, varies among
different races, ages and genders. It is considered to be of
primary importance in facial expression and beauty. We
present one form of the ideal eyebrow aesthetic and discuss
methods of optimising surgical results. For the modern
acceptable concept of the ideal brow, the medial brow
should begin on the same vertical plane as the lateral extent
of the ala and the inner canthus and end laterally at an
oblique line drawn from the most lateral point of the ala
through the lateral canthus. The medial and lateral ends of
the brow lie approximately at the same horizontal level.
The apex lies on a vertical line directly above the lateral
limbus. Individual perceptions and expectations also differ
from person to person. The brow should over lie the orbital
rim in males and be several millimetres above the rim in
female. Male tend to have a heavier, thicker brow with a
little arch present. There are some pitfalls in brow aes-
thetics. Overelevation creates an unnatural, surprised and
unintelligent look which is the most common surgical
mistake in brow lifting. Medial placement of the brow peak
would create an undesired ‘surprised’ appearance. More-
over, a low medial brow with a high lateral peak induces an
angry look. Overresection of the medial brow depressors
may lead to widening and elevation of the medial brow,
which creates an insensitive look and can also lead to
glabellar contour defects. It is impossible to define an ideal
eyebrow that is suitable for every face. However, one must
consider previously described criteria and other periorbital
structures when performing a brow surgery.
Keywords Eye brow Facial expression Beauty
Introduction
Facial aesthetics have been described and evaluated since
the Renaissance by artists and scholars, including Leonardo
da Vinci, Bergmuller, and Elsholts [1]. In addition to these
neoclassical canons, in the late nineteenth century the
science of anthropometry was applied in clinical practice
[2]. Knowledge of the ideal facial aesthetic proportions is
vital to achieve ideal outcomes and avoid complications.
In particular, the upper third of the face, including the
eyebrows and eyelids, varies among races, ages and gen-
ders. In facial expression and beauty, the upper third of the
face is considered to be of primary importance [3]. The
brow is known as the master line of the face, used as a
reference for all other angles and contours of the face [4].
E. Yalc¸ınkaya
ENT Clinics, Ear, Nose, Throat and Plastic Surgery Center,
Ankara, Turkey
C. Cingi
Department of Otorhinolaryngology, Medical Faculty, Eskisehir
Osmangazi University, Eskisehir, Turkey
H. So
¨ken
ENT Department, Eskis¸ehir Military Hospital, Eskis¸ ehir, Turkey
S. Ulusoy
ENT Clinics, GOP Taksim Education and Research Hospital,
Istanbul, Turkey
N. B. Muluk
Department of Otorhinolaryngology, Medical Faculty, Kirikkale
University, Kirikkale, Turkey
N. B. Muluk (&)
Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 62/43,
06610 C¸ ankaya/Ankara, Turkey
e-mail: nbayarmuluk@yahoo.com; nurayb@hotmail.com
123
Eur Arch Otorhinolaryngol
DOI 10.1007/s00405-014-3356-0
The aesthetic importance of the eyebrow has been high-
lighted for centuries. However, there is great variety in the
shape and position of the eyebrows; therefore, it is difficult
to define ‘ideal’ criteria for all faces.
In this paper, we review the literature, present one form
of the ideal eyebrow aesthetic and discuss how to optimise
the surgical results.
Anatomy
The supraorbital ridges or arches form the upper boundary
of the orbit and demarcate the midface from the forehead.
The medial one-third of the rim tends to blend into the
glabella. The lateral one-third of the rim is well defined and
forms an overhanging ledge [5].
The frontalis muscles are the only muscles that can
elevate the brow. These muscles are paired extensions of
the galea aponeurotica and insert into the supraorbital
dermis by interdigitating with the orbicularis oculi muscle.
The galea is continuous with the superficial temporal fascia
laterally and the superficial muscular aponeurotic system
inferiorly. Contraction of these muscles leads to transverse
to forehead wrinkling [6,7].
The depressors of the brow are the procerus, corrugator
supercilii, depressor supercilii, and orbicularis oculi muscles.
Of these muscles, the corrugator plays the dominant role. The
procerus muscles originate from the upper lateral cartilages
and nasal bones to insert into the glabellar skin. Contraction
produces transverse wrinkling at the radix of the nose [6,7].
The corrugator muscle has a transverse and an oblique
head. The procerus, depressor supercilii, and the oblique
head of the corrugator muscle originate from the superior-
medial orbital rim and insert under the medial eyebrow
dermis. The transverse head originates from the medial-
superior orbital rim and inserts into the dermis of middle
third of the eyebrow. This transverse head moves the
eyebrow medially [6,7].
The orbital portion of the orbicularis oculi muscles in-
terdigitates with the corrugators medially and continues
around the lateral cantus into the zygomatic area. Con-
traction results in downward displacement of the eyebrow
(especially the lateral portion) [6,7].
Thesensorynervesoftheforeheadarethesupraorbital
and supratrochlear nerves. The motor nerve is the tem-
poral branch of the facial nerve. This nerve supplies the
frontalis muscle, the superior orbicularis muscle, the
transverse head of the corrugator supercilii muscle, and
the superior end of the procerus muscle. The zygomatic
branch of the facial nerve supplies the inferior orbicularis
oculi muscle, the inferior end of the procerus muscle, the
depressor supercilii muscle, the oblique head of the cor-
rugator supercilii, and the medial head of the orbicularis
oculi muscle (Fig. 1)[7,8].
Pathophysiology
Prolonged hyperactivity of the upper facial musculature
produces three deformities in the forehead–brow complex;
transverse forehead wrinkling (frontalis muscles), brow
ptosis (corrugator and orbicularis muscles), and glabellar
wrinkling (corrugator, orbicularis, and procerus muscles)
[9].
The three forces that act on brow ptosis are: (1) the
frontalis muscle resting tone, which suspends the eyebrow
medial to the temporal fusion line of the skull; (2) gravity,
which causes the soft-tissue mass push the eyebrow seg-
ment downward; and (3) corrugator supercilii muscle
hyperactivity in conjunction with orbicularis oculi muscle,
which can antagonise frontalis muscle activity and facili-
tate descent of the eyebrow [9,10].
The lateral segment of the eyebrow develops ptosis
earlier in life than the medial segment. According to Knize
[11], the lateral segment has less support than the medial
brow from deeper anatomical structures, causing this lat-
eral segment ptosis. On the other hand, Lemke [12] sug-
gests that the anatomical limits of the frontal muscle fibres
do not extend as far laterally as the lateral part of the brow.
Thus frontalis contraction cannot prevent lateral brow
ptosis.
Fig. 1 Periorbital motor nerves and the muscles they activate [7,8].
TB and ZB temporal and zygomatic branches of the facial nerve, FM
frontalis muscle, CSM corrugator superficialii muscle, DSM depressor
supercilii muscle, PM procerus muscle, ZM zygomaticus major
muscle
Eur Arch Otorhinolaryngol
123
Aesthetic review
Eyebrow aesthetics are influenced by various factors,
including age, sex, culture, ethnicity, and current fashion
trends. Further, the surrounding periorbital features also
affect eyebrow appearance.
Since the eighteenth century, much research has aimed
to define useful criteria for eyebrow aesthetics. According
to the art historian Johann Winckelmann, the Greek ideal
of a beautiful brow forms a delicate arch just over the brow
bone and grows over the nose [13]. Westmore [14]
described the modern acceptable concept of the ideal brow.
According to Westmore (Fig. 2)[14]:
1. The medial brow should begin on the same vertical
plane as the lateral extent of the ala and the inner
canthus (A–B).
2. The medial brow ends laterally (C) at an oblique line
drawn from the most lateral point of the ala
(A) through the lateral canthus.
3. The medial and lateral ends of the brow (B, C) lie
approximately at the same horizontal level.
4. The apex lies on a vertical line (D–E) directly above
the lateral limbus.
Ellenbogen [15] largely supported Westmore’s criteria;
however, he reported that the caudal hairs of the medial
brow must be 1 cm above the supraorbital rim. On the
other hand, Whitaker et al. [16] stated that the medial end
of the brow should be below the supraorbital ridge. Addi-
tionally, they reported that the apex should be at the
juncture of the middle and lateral thirds.
Cook et al. [17] relieved the brow positions of numerous
attractive females. In addition to Westmore, they thought
that the apex should be further lateral to the lateral cantus.
They felt that Westmore’s model for the apex would result
in a ‘surprised’ look.
Connell [18], Matarasso and Terino [19], and McKinney
[20] contributed various guidelines for ideal brow position.
Connell [18] described the distance between the upper
eyelid crease and the lower edge of the eyebrow as 15 mm.
In contrast, Matarasso and Terino [19] described this dis-
tance as 1.6 cm. Additionally, they stated that the distance
Fig. 2 Ideal brow shape (from Westmore) [14]
Fig. 3 The distance from midpupil to the top of the brow should be at
least 2.5 cm. The forehead height averages 5 cm in female and 6 cm
in male [20]
Fig. 4 Attractive eye (from Gunter) [21]
Eur Arch Otorhinolaryngol
123
between the eyebrow and midpupil should be 2.5 cm, that
between the eyebrow and the supraorbital rim should be
1 cm, and from the eyebrow to hairline should be 5–6 cm.
McKinney [20] reported that the distance from the mid-
pupil to the upper edge of the eyebrow is 2.5 cm and the
distance from the upper edge of the eyebrow to the hairline
5 cm, on average (Fig. 3)[20].
Gunter [21], found that it is difficult to evaluate ideal
brow without considering other periorbital features. They
formulated the following criteria for attractive eyes
(Fig. 4):
1. The intercanthal axis should be tilted slightly upward
from medial to lateral.
2. The upper lid should cover the iris approximately
1–2 mm.
3. The medial portion of the upper lid margin should be
in a more vertical plane than the lateral upper lid
margin.
4. The upper lid crease should parallel the lash line and
divide the upper lid into an upper two-thirds and a
lower one-third (approximately, but never more than, a
1:1 ratio).
5. The medial extension of the supratarsal upper skin fold
should not exceed the inner extent of the medial
canthus.
6. The lateral extension of the supratarsal upper skin fold
should not extend beyond the lateral orbital rim.
7. There should be minimal, if any, scleral show between
the lower lid and iris.
8. The lower lid margin should bow gently from medial
to lateral, with the lowest point between the pupil and
the lateral limbus.
Angres [22] classified intercanthal distance either as
‘well-spaced’ (normal intercanthal distance), ‘wide-set’
(increased intercanthal distance), or ‘close-set’ (decreased
intercanthal distance). He agreed with Westmore on the
medial brow position. However, he stated that the brow
should begin medial to the medial canthus for an increased
intercanthal distance, and likewise, the brow should begin
lateral to the medial canthus for a decreased intercanthal
distance [22].
Baker [23] suggested that the ideal brow varies among
facial shapes. The Westmore eyebrow is not ideally suited
for long or square faces. In long faces, a flatter brow may
be more suitable. In contrast, a lateral curvature may help
to soften the angles of a square face.
The ideal brow shape and position varies between male
and female. The brow should over lie the orbital rim in
male and be several millimetres above the rim in female.
Male tend to have a heavier, thicker brow, with little arch
present. In female, the eyebrow tends to have a pleasant
arch peaking in the lateral third of the eyebrow and
furthermore, a club-shaped medial portion. In male, the
lateral brow is more prominent [24,25].
Browlift techniques
The major goals of this surgery are the restoration of brow
position, shape, and symmetry. For a soft, aesthetically
pleasing result, it is important to avoid overcorrection of
the brow position and excessive elevation of the medial
brow. Numerous browlift techniques have been defined,
including the coronal lift, the endoscopic brow lift, the
pretrichial lift, the midforehead lift, the direct browlift and
the internal browlift [26].
Coronal brow lift
This technique utilises either a pre-trichial or post-trichial
incision, and has the advantage of allowing correction of
glabellar frown lines and forehead rhytids while lifting the
brow. This technique is not appropriate for those patients
with a high hairline or those with thinning hair. There are
numerous potential complications following this procedure
including sensory and motor nerve dysfunction, skin
necrosis, permanent overcorrection, alopecia, abnormal
soft tissue contour, and eyebrow and eyelid asymmetry
[26].
Endoscopic techniques
Endoscopic methods of brow lifting have comparable
success rates to open coronal lifting, but a significantly
lower incidence of complications and a faster rehabilitation
time [26]. Withey et al. [27] reported the complications of
endoscopic techniques as postoperative numbness, itching,
hair loss, tissue swelling and asymmetry.
The pretrichial lift
Pretrichial denotes an incision in front of the hairline. It is
advisable to make the bevelled incision about 2 mm behind
the hairline to induce hair growth through the scar and
improve cosmesis [28].
Mid-forehead lift
The mid-forehead lift utilises a forehead crease as the
foundation of the incisions. This technique can be used to
good effect especially in men who have deeper forehead
creases and receding hairlines. The potential disadvantages
are the same as for a direct lift, in terms of scarring and
altered sensation [26].
Eur Arch Otorhinolaryngol
123
The direct brow lift
The direct brow lift is a simple procedure which allows the
surgeon good control over the amount of tissue excised,
and therefore, the degree of lift achieved, as well as the
postoperative contour of the brow. Nevertheless, the
resulting scar may result in poor cosmesis, and damage to
the supraorbital nerve may lead to paraesthesiae or
numbness over the forehead region [26].
Internal brow lift (browpexy) or trans-blepharoplasty
browpexy
This technique achieves brow elevation or fixation through
a standard blepharoplasty incision. The lateral eyelid is
debulked by excising the descended lateral galeal and
preseptal fat pad, and the brow is anchored with mattress
sutures to the periosteum above the supraorbital rim. The
procerus and corrugator muscles may be approached
through the same incision if required. Advantages are
simplicity and placement of the wound within a naturally
occurring skin crease. Disadvantages include the limited
amount of brow lift which can be achieved, and damage to
the supraorbital neurovascular bundle if the medial portion
of the brow is approached [26].
Pitfalls
The upper third of the face, especially the eyebrows, have a
major role in facial appearance and expression. For
example, in the mobile phone game, Angry Birds [29],
eyebrows that tend laterally (Fig. 5a) transmit sadness,
those that tend medially (Fig. 5b) transmit anger, low
eyebrows transmit fatigue (Fig. 5c), and properly aligned
eyebrows (Fig. 5d) transmit an alert, rested countenance
that allows the mouth to transmit the smile.
Overelevation creates an unnatural, surprised and unin-
telligent look. This is the most common surgical mistake in
brow lifting. In male patients, the eyebrow sits lower than
in female and has a flatter contour; therefore, overlifting
may feminise the patient’s appearance [30]. Additionally,
medial placement of the brow peak would create an
undesired ‘surprised’ appearance. Moreover, a low medial
brow with a high lateral peak induces an angry look [31].
Slight asymmetries between the eyebrows are natural and
common. Nevertheless, greater asymmetries in height
cause a curious appearance [32].
Overresection of the medial brow depressors may lead
to widening and elevation of the medial brow, which cre-
ates an insensitive look and can also lead to glabellar
contour defects. Caution must be used when elevating the
brow in patients with deep-set eyes. Brow elevation can
unmask the hollowing above the globe and results in
prominence of the supraorbital rim, which creates an
emaciated look [33].
The distance from the superior edge of the eyebrow to
the hairline is usually 5–6 cm. If this gap is larger, caution
must be used during brow lift procedures that may further
raise the hairline [20].
Troilius [34] re-evaluated patients who underwent
endoscopic subperiosteal brow-lifting surgery. He found
that the great majority of patients had an average of
2.5 mm higher eyebrows 5 years postoperatively compared
to 1 year after surgery. Graf [35] also determined a pro-
gressive spontaneous increase in eyebrow height. Addi-
tionally, this elevation started in the medial portion of the
brows. They hypothesized that medial elevation depended
on unopposed action of the frontalis muscle. Two years
after surgery, lateral points were also elevated. They con-
sidered that this situation was due to the release of the
periosteum, temporal, and periorbital adhesions, leaving
the frontal muscle to pull up the brows. While brow lifting,
one must take into account this spontaneous elevation after
endoscopic surgery.
Conclusion
Brow shape and position vary among ages, races and
genders. Individual perceptions and expectations also differ
from person to person. It is impossible to define an ideal
Fig. 5 Eyebrows of Angry
Birds illustrate eyebrow
placement, denoting asadness,
banger, ctiredness, or dsmile
[29]
Eur Arch Otorhinolaryngol
123
eyebrow that is suitable for every face. However, one must
consider previously described criteria and other periorbital
structures when performing a brow surgery.
Acknowledgments Preparation of this paper including designing
and planning was supported by Continuous Education and Scientific
Research Association.
Conflict of interest The authors declare that there is no conflict of
interest.
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Background: Multiple penetration depths of high-intensity focused ultrasound (HIFU) treatment for facial rejuvenation have not been quantified. Methods: We enrolled 12 participants (n=24) to undergo one session of HIFU rejuvenation between January 1, 2019, and January 10, 2020. We used a 2-, 4.5-, and 6-mm focal depth transducer on the upper and middle face. We evaluated efficacy on days 60 and 90 by using our specific assessment system. Results: The average eyebrow peak and pupil-eyebrow peak angles significantly increased by 2° (p < 0.0005) and decreased by 1° (p < 0.0001), respectively, at day 90. The shortened eyebrow-iris length indicated that the forehead tissues had lifted and moved medially to the central face. Supraorbital tissues were also vertically elevated, marked by the eyebrow-orbital (p = 0.0016) and vertical palpebral fissure lengths (p = 0.0052), which both exhibited a 0.8-cm elevation. For the midface, the increased canthus-oral-nasal angle (p = 0.5881) and decreased tragus-oral length (p = 0.5881) indicated that laxity had been corrected through lifted oral commissure, though the data were not statistically significant. No serious side effects were observed. Conclusion: HIFU treatment with multiple depths quantitatively improved both upper-facial rejuvenation and midface rejuvenation after a single session.
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Purpose Brow ptosis can interfere with blepharoplasty results and can be corrected using several techniques. The present study was performed to compare two techniques for brow suspension, both with concomitant upper eyelid blepharoplasty. Method A prospective, interventional, randomized study involving 27 female patients was performed to compare the effects of two different techniques of brow suspension: eyebrow suspension with nylon thread (ESN) and internal browpexy fixation (IBF), both combined with upper lid blepharoplasty. Qualitative assessment was carried out using a questionnaire, and quantitative angular measurement analysis of the brow position was performed using digital photographs taken with a Vectra H1 camera before, 60, and 120 days after surgery. The data were transferred to an Excel table and statistically analyzed. Results ESN was performed in 14 patients and IBF in 13 patients. Both groups were homogeneous in terms of age. The main preoperative complaints were excess skin on the upper eyelid (81.4%) and reduced visual field (59.2%) in both groups. Most of the patients expected aesthetic improvement, and the surgical results were considered satisfactory for all of them. There was no significant difference between ESN and IBF in the quantitative evaluation of eyebrow position. Conclusion Both ESN and IBF resulted in a high degree of patient satisfaction. Both techniques provided similar brow suspension, emphasizing that IBF is technically easier to perform and produces less scarring.
Article
Background: Eyebrows define one's facial appearance; brow ptosis, which can occur with aging, can convey a negative expression. Various methods have been used to correct eyebrow position and shape. We endeavored to repair brow ptosis and glabellar wrinkles and present the outcome. Methods: This retrospective study reviewed 40 patients who underwent extended suprabrow lift accompanied by relief of glabellar wrinkles between January 2018 and August 2020. The procedure was considered when patients exhibited brow ptosis, glabellar wrinkles, and a wide forehead. Fat graft was implemented after glabellar muscle division. The results were assessed based on measurements performed preoperatively and at 6 and 18 months postoperatively. Results: Overall, patients were satisfied with the outcomes. To assess glabellar wrinkles, the Modified Fitzpatrick Wrinkle Assessment score revealed adequate correction during neutral and furrowed gazes (P < 0.05). The forehead and brow heights were also analyzed after repair, exhibiting decreased forehead height and elevated brow position (P < 0.05). At 6 and 18 months after surgery, adequate maintenance of the repair was evident (P < 0.05). A visible scar was observed in two patients, which was managed using a fractional ablative laser procedure. Conclusion: Extended suprabrow lift, when based on preoperative measurements, led to the correction of brow ptosis, glabellar wrinkles, and a wide forehead. For periorbital rejuvenation, it is imperative to decide locations where the skin and soft tissues should be preserved or removed. The use of fat grafts for wrinkle repair effectively maintains the repair postoperatively. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
The face is central to individual identity and gender presentation. Sex-based differences are seen at nearly every component of the face, from craniofacial structure to skin and soft tissue distribution. This article provides a framework for identification and analysis of sex-based differences in facial anatomy. This can then be used to guide individualized approaches to surgical planning to create greater congruence between patients' existing physical features and goals for gender expression.
Article
Direct browlifting comprises various techniques to lift the brows using incisions on or around the brows. The classic direct browlift involves removing an ellipse of skin and subcutaneous tissue within or just above the brow cilia. However, the technique can be modified to address only lateral brow ptosis, to place the incision in the midforehead or the eyelid crease, and to place the incisions in different areas during bilateral surgery to attempt to improve symmetry. Careful attention to incision location, closure technique, and use of postoperative therapies can allow for nearly invisible scars in some cases.
Article
Résumé Depuis quelques années, le microblading connaît une popularité grandissante. Il s’agit d’une forme de micropigmentation superficielle, durant laquelle le pigment est déposé uniquement jusqu’au derme papillaire, à l’aide d’aiguilles superposées, disposées comme un scalpel. Les traits nets et discrets qui en résultent permettent de reproduire un sourcil naturel, qui est l’unique indication de cette technique. Les patients souffrant de pelade, d’hypotrichose, d’hypothyroïdie etc. peuvent être intéressés par cette alternative aux résultats plus naturels que le simple trait de couleur qu’offre un maquillage permanent classique. Nous faisons ici le point sur cette technique et ses possibles complications.
Article
The techniques presented in article will allow the facial plastic specialist to use the anatomy of each individual patient as a guide for the surgical release of the brow performed during endoscopic brow lift. The author presents his 15 years of experience in which he developed this approach. Five different surgical releases of the brow will be demonstrated and discussed in terms of which patients would best benefit from which release. Adopting this approach has made the predictability of the authors brow lift results much better and therefore improved patient satisfaction. This concept has not been described in the literature and the author firmly believes using a preoperative anatomical approach is a better way to approach endoscopic brow lift surgery.
Article
The brow lift operation aims to correct the loss of soft tissue elasticity in the upper third of the face, which may lead to ptosis of the brow and hypertonicity of the frontalis, corrugator supercilii, and procerus muscles with subsequent wrinkling of the forehead (see the image below). This confers a look often described as tired. Several techniques are available to correct this occurrence depending on the individual patient's needs and desires. Preoperative view of forehead of an ideal patient.
Article
Background/aims: The direct brow lift operation can be used to treat brow ptosis arising from either involutional changes or facial nerve palsy. The authors reviewed their experience with this operation to establish its efficacy and complication rate in the light of concerns over poor scar cosmesis and forehead paraesthesiae in the postoperative period. Methods: A retrospective review of patients undergoing direct brow lifting from 1989 to 2002 was conducted, and information gained on patient satisfaction by questionnaire. Results: The direct brow lift operation was found to give a predictable outcome, with high levels of patient satisfaction. With careful wound closure, postoperative scars are rarely cosmetically unacceptable to the patient. Paraesthesiae are a common but well tolerated sequelae. Conclusions: The direct brow lift was found to be a reliable method for treating brow ptosis arising through involutional change or facial nerve palsy in both men and women. The postoperative scars may be more evident in younger patients so the authors reserve this technique for “rehabilitative” rather than cosmetic brow lifts in patients of middle age and beyond.
Article
Lasting elimination of forehead wrinkles and glabellar frown may be achieved by a partial resectioning of the muscles of the forehead. In those cases in which the eyebrows are also lifted, we use a line of incision which is similar to the blepharoplasty of the upper lids used by Morel-Fatio. We carry out the resectioning of the muscle more extensively than is generally described in the literature. It has hereby been observed that the partial resectioning of the musculus frontalis leads to a smoothing out of the horizontal forehead wrinkles, without a tightening of the skin. The results were always satisfactory both for the patients and the surgeons, and the rate of complication was minimal. A result acceptable to the patient can be achieved only if she has been thoroughly informed in advance.
Article
The longevity of a brow lift, its morphology, and its contribution to overall facial aesthetics have not been addressed in previous studies using both objective measurements and validated subjective aesthetic scoring systems. Thirty-one patients with a 5.4-year follow-up after subperiosteal endoscopic brow lift were assessed by (1) objective measurements using computer software, (2) validated regional aesthetic scoring systems, and (3) global aesthetic scoring systems. In part 1, objective measurements confirm a subtle elevation of the brows at less than 5 mm (p < 0.001) that persisted at 5.4 years after surgery in all areas except the tail of the eyebrow. In part 2, subjective regional aesthetic scoring indicated that the dimensional change is small but apparent to observers, and is maintained at 5.4 years; that depressor muscle resection with a brow lift provides a statistically significant reduction in glabellar lines, which is maintained at 5.4 years; and that a brow lift provides temporary improvement in forehead lines but that this improvement relapses to baseline at 5.4 years. In part 3, global aesthetic scores suggest that 64 percent patients are still judged as appearing better 5.4 years after a brow lift than before surgery. This is the first study to provide evidence from both objective measurements and validated subjective aesthetic scoring systems regarding the morphology, benefits, and longevity of endoscopic brow-lift surgery. This demonstrates that a brow lift produces a subtle elevation, with a natural eyebrow morphology close to the original, and with minimal long-term relapse except at the tail of the eyebrow. Therapeutic, IV.
Article
The area of the upper face occupies about one third of the surface area of the whole face. The anatomical landmarks involve the forehead, brow, glabella and the upper lids. Gravitational and intrinsic changes, as well as familial problems affect the aesthetics of the upper face. The author describes the anatomy and pathophysiology of ageing and the importance of making a correct diagnosis. Surgical and non surgical solutions are discussed. The concept of the beneficial effect of antioxidants such as curcumin is introduced. The efficacy of non ablation laser in dermal rejuvenation is explained. The author aims to impart a thorough understanding of the different surgical and non-surgical options for rejuventating the upper face to achieve an unoperated outcome with a healthy looking forehead.
Article
To develop a standard measure of eyebrow position for evaluation of eyebrow ptosis and to provide normative measurements for eyebrow position using this easily reproducible measure. A noncomparative interventional case series was performed. Measurements of eyebrow position were made on 213 subjects without cosmetic or functional complaints who presented to the eye clinic for routine eye examination during a 1-year period. Measurements were taken in the primary position of gaze. Central eyebrow height was measured as the distance from the central inferior corneal limbus to the first row of mature brow hairs (ILB) under loupe magnification. Additional measurements included the distance from the upper eyelid margin to brow, margin reflex distance-1, and palpebral fissure width. Of the 213 subjects, 56 (26.5%) were male and 157 (73.5%) were female. Ages ranged from 5 to 80 years. Mean ILB height was 19.4 mm for males and 19.7 mm for females. The ILB was not associated with measures of eyelid height such as palpebral fissure width. There was no statistically significant difference in ILB height between males and females. However, increased ILB height was associated with increased age. African Americans had statistically significant increased mean ILB measurements compared with whites. Measurement of ILB height provides an accurate and easily reproducible measure of eyebrow height that may be useful in the diagnosis and treatment of conditions affecting the middle and upper face. Race, but not sex, seems to be an important consideration in proper central eyebrow position.
Article
Recognition of the brow as an integral contributor to periocular appearance improves and prolongs results from facial rejuvenation surgery. The approach to the brow and forehead in periocular rejuvenation must be chosen on an individual basis. The approaches discussed require in-depth knowledge of complex forehead and temporal anatomy to navigate the planes and important neurovascular structures safely. This article discusses anatomy, preoperative evaluation and considerations, surgical techniques, and complications in rejuvenation of forehead and brow.