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Objective evaluation of the eyelids and eyebrows after blepharoplasty.

PURPOSE: Surgery of the upper and lower eyelids and eyebrows is primarily designed to enhance the esthetic appearance and provide functional visual field benefits. Paramount to successful surgical results is a carefully executed examination and treatment plan. The preoperative and postoperative evaluation of these individuals has been primarily subjective. This article describes a method for the quantification of periorbital relationships that is of use in the preoperative planning and postoperative evaluation of patients undergoing esthetic surgery of the eyelids and eyebrows. PATIENTS AND METHODS: The photographic records of 15 female patients who had undergone bilateral upper eyelid surgery were examined. None of the patients underwent lower eyelid or eyebrow surgery. Preoperative and postoperative frontal photographs were projected to a standard size, and measurements were made in a standardized fashion. For the comparison of intrapatient and interpatient relationships, objective anthropometric proportions rather than average measurements were used. Therefore, standard periorbital relationships were recorded and expressed as anthropometric ratios. Measurements were recorded for 30 eyes. The preoperative and postoperative relationships were measured and reported as mean values with standard deviation. The relationships studied were: 1) Upper lid height to orbit height, 2) Lower lid height to orbit height, 3) Lid sulcus height to orbit height, 4) Lid sulcus height to upper lid height, 5) Upper iris coverage to iris height, 6) Lower iris coverage to iris height, 7) Orbit height to middle facial height, 8) Medial brow to orbit height, 9) Lateral brow to orbit height, and 10) Eye fissure height to orbit height. Brow heights were measured vertically from a line connecting exocanthion and endocanthion. RESULTS: The postoperative changes in these patients showed the following: Upper lid height, eye fissure height, and brow position were not significantly affected by upper lid blepharoplasty surgery. The sulcus lid height was doubled postoperatively, and upper iris coverage was decreased slightly postoperatively. CONCLUSIONS: The results of the study indicate that the proposed methodology is appropriate for the objective evaluation of periorbital relationships pertinent to esthetic periorbital surgery. Its use is suggested as a diagnostic aid in preoperative planning and postsurgical evaluation.

Adult↗

Dermatography as a new treatment for alopecia areata of the eyebrows.

BACKGROUND: Alopecia areata is considered to be an autoimmune disease. It consists of patchy hair loss of the scalp and the eyebrows, making it a disfiguring condition. This 10-year study was designed to assess the usefulness of the treatment of the eyebrows with dermatography as a relatively quick and simple method to obtain a cosmetically satisfactory result. MATERIALS AND METHODS: The eyebrow areas were covered with a halftone pattern of tiny dots of color pigments, using a Van der Velden Derma-injector, without anesthesia. On average, two to three dermatography sessions of 1 h were required. The follow-up was 4 years. RESULTS: Thirty three patients, most of whom had been previously treated with a sensitizer such as dinitrochlorobenzene (DNCB), were treated with dermatography. Four patients had also been treated by a beautician with a crude form of tattooing. The results in 30 patients were excellent. In three patients the results were good. CONCLUSIONS: Dermatography is a technique offering a good alternative for time-consuming, troublesome treatment modalities that often have considerable side-effects. With dermatography, no side-effects were found.

Adolescent↗

Raising eyebrows with botulinum toxin.

BACKGROUND: Brow elevation rejuvenates the facial appearance. OBJECTIVE: To determine if a significant degree of brow elevation could be achieved through selective botulinum toxin treatment of brow depressors. METHODS: Seven women aged 31-42 (mean 37) years old were treated. The distance from lowest eyebrow cilium of the eyebrow to the midpupillary point was measured before and 1 month posttreatment. Botulinum toxin was injected into the glabellar area (7-10U) and the supralateral eyebrow (0-2.5U each side), to a total dose of 10-14 U. RESULTS: Five individuals (71%) showed brow elevation of 1-3 mm with a mean elevation of 1 mm. Two individuals showed no change. Concurrent weakening of the frown response was noted in all patients. CONCLUSION: Botulinum toxin treatment of brow depressors produces a small degree of brow elevation in the majority of patients.

Adult↗

Eyebrow reconstruction with the subcutaneous island pedicle flap.

BACKGROUND: Surgical defects of the eyebrow region routinely present a cosmetic challenge to the reconstructive surgeon. OBJECTIVE: To present the use of a commonly employed reconstructive technique for an uncommon location. METHODS: Defects and repairs are demonstrated to illustrate techniques and document outcomes. The biomechanical influences on flap choice are explored. RESULTS: The subcutaneous island pedicle flap yielded excellent functional and cosmetic results when medium or larger defects were confronted in the eyebrow region. A centrally based pedicle enhanced cosmetic outcome, while rendering an uncompromised vascular supply. CONCLUSION: The subcutaneous island pedicle flap provides a competitive repair alternative when reconstructing substantial defects of the eyebrow region.

Eyebrows↗

A percutaneous approach to eyebrow lift: the Salvadorean option.

BACKGROUND: Surgical eyebrow lift can result in a number of complications. A nonsurgical simple method of lifting the brow is presented. OBJECTIVE: To raise the eyebrows using a simple, quick, and noninvasive approach. METHODS: Twenty-nine patients, 27 women and 2 men, whose ages varied from 24 to 56 years (mean of 32 years) were included in the study. Preoperative and postoperative photographs were taken. In two patients, brow suspension was performed at the time of blepharoplasty. Informed consent was signed by all of the patients. For measuring the degree of satisfaction of the patients, we gave to them a sheet grading it from one to three (with one being the least satisfactory). Local anesthesia (1% lidocaine, 1:400,000 epinephrine), a conveniently sized Keith needle, and prolene 3/0 sutures were used. RESULTS: Satisfying results were obtained in all cases. The only problem encountered in two patients was temporary edema, and it settled in a few days. CONCLUSION: This is a very simple, quick, and noncomplicated method of raising the eyebrows. It can be repeated, revised easily, or combined with other modalities, such as peels, topical tretinoin, oral isotretinoin, fat injection, Goretex, and Botox as part of a facial rejuvenation program.

Adult↗

Eyebrow incision using tattoo for anterior fossa lesions: technical case reports.

Some Korean women draw tattoo in their eyebrow to cover the scant hair. If a patient has a tattoo in her eyebrow, lesions of anterior cranial fossa can be easily managed with this small eyebrow skin incision through a small unilateral supraorbital craniotomy. By this technique, 7 cases of anterior cranial fossa lesions were successfully treated without any major complications. This leads to less facial scar, less operation time and an earlier return to social adaptation.

Adult↗

The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base.

OBJECTIVE: This study evaluates the technique, indications, advantages and limitations of the minimal invasive supraorbital keyhole approach via an eyebrow skin incision for resection of tumors around the sella and the anterior skull base. METHODS AND RESULTS: In 9 patients (5 males, 4 females) different tumors (6 meningiomas, 1 craniopharyngioma, 1 Rathke's cleft cyst and 1 hypophysitis) with a maximum diameter of 30 millimeters were resected via a small eyebrow incision and a supraorbital keyhole craniotomy. Details of the operative procedure include the use of a high-speed drill, a microsaw, bayonet-shaped instruments, careful microsurgical dissection, the use of a neuroendoscope and miniplates for closure. In all patients complete tumor removal was achieved. Mean duration of surgery was 01 h 51 min and mean hospital stay was 8.9 days. There were no significant postoperative complications. Clinical examination and MR imaging after a mean follow-up of 313 days revealed no tumor recurrence and a very satisfying overall functional and cosmetic result in all patients. CONCLUSION: The eyebrow incision supraorbital keyhole approach proved to be safe, effective and time-sparing. The authors recommend this approach for resection of small tumors around the sella and the anterior skull base in selected cases as a valuable alternative to standard skull base approaches.

Adult↗

A method of direct eyebrow lift.

A very simple procedure, requiring about twenty minutes, accomplishes moderate elevation and support of the eyebrows. It may be utilized for eyebrow ptosis alone, whether unilateral or bilateral; in conjunction with meloplasty and blepharoplasty; for equalizing asymmetrical eyebrows, and for further support of markedly ptotic upper lids. It has been used by the author in instances of partial and complete facial paralysis in conjunction with other procedures about the face to accomplish better symmetry. The duration of results with this procedure varies with tissue quality and healing, surgical technique, care given the area during healing by the patient, amount of frowning and vigorous facial muscle use by the patient, and aging. It is a useful adjunct, especially when used for moderate or subtle brow lifts.

Aging↗

Eyebrow revascularization.

A 41-year-old man suffered from an incompletely avulsed right eyebrow and forehead after a windshield injury in a traffic accident. Microsurgical techniques were used to revascularize the avulsed tissue of the right eyebrow and forehead with anastomosis of one branch of the frontal branch of the right superficial temporal artery. The revascularized eyebrow and forehead remained viable and provided a good cosmetic result. An aggressive microsurgical approach, either by direct arterial anastomosis or bypass with vein graft, should be encouraged in all incompletely avulsed tissue with inadequate blood supply in the face, hand, and foot.

Adult↗

New eyebrow lift technique using a semiautomatic suturing device (maniceps) for patients with facial paralysis.

Direct browlift and the traditional fascial suspension technique sometimes leave a prominent scar above the eyebrow. Coronal browlift, mid-forehead browlift, and endoscopic browlift leave no prominent scar, but they are sometimes not suitable for patients with facial paralysis because they have been developed for rejuvenative surgery. The authors present a new browlift fascial suspension technique for patients with facial paralysis. This method uses a semiautomatic suturing device (Maniceps), which they have used to graft three fascial strips to the forehead from the fascia lata, and to suspend and lift the eyebrow with only two small incisions posterior to the hairline. The authors treated 13 facial paralysis patients, with follow-up periods of more than 6 months. The lifted eyebrows adapted to stabilized positions within 3 months. The results in all 13 patients were satisfactory, with no severe complications. This new technique is very useful because it has wide applicability, including facial paralysis patients who experience severe ptosis.

Adult↗

Pilomatrixoma of the eyelids and eyebrows in children and adolescents.

PURPOSE: To review the clinical features of pilomatrixomas of the eyelids and eyebrows in children and adolescents. METHODS: The authors reviewed the medical records of 95 patients, all of whom were 20 years old or younger and had the histopathologic diagnosis of pilomatrixoma made from 1976 through 1995. Special attention was given to that subgroup of patients with tumors involving the eyelids and eyebrows. Data analyzed included age at diagnosis, patient sex, location and size of tumor, preoperative diagnosis, and clinical description of tumor. RESULTS: Eleven (12%) of 95 patients had lesions involving the eyelid or eyebrow. Six of those patients (55%) were female. Eight patients (73%) were 10 years old or younger, and three were 11 to 20 years old. The tumor occurred on the upper lid or in the brow in eight patients, the lower eyelid in two patients, and the medial canthus in one patient. Tumor diameter was 1 cm or less in all 11 patients. Pilomatrixoma was included in the preoperative differential diagnosis in only four of the 11 patients. The most common misdiagnoses were epidermoid and dermoid cyst. Three patients had pink or blue discoloration of the overlying skin, two had visible yellow-white patches in the tumor, and two had dilated vessels on the tumor surface. CONCLUSIONS: Pilomatrixoma is an uncommon tumor that can occur on the eyelids and in the brow region of children and adolescents. It is commonly misdiagnosed preoperatively as an epidermoid or dermoid cyst. Distinctive clinical features, however, suggest the correct diagnosis.

Adolescent↗

Congenitally anomalous tented eyebrows.

PURPOSE: An uncommon congenital anomaly of the eyebrows is described. METHODS: Case report and review of the literature. RESULTS: Two articles in the English literature were found describing patients similar to ours. CONCLUSIONS: Congenital upward tenting of the midportion of the eyebrows, resembling the eyebrow line of an owl, is uncommon. This anomaly is thought to be transmitted in an autosomal dominant fashion and may be accompanied by myopia and strabismus, but has not been associated with systemic disease.

Child↗

Eyebrow reconstruction in the burn patient.

Eyebrow reconstruction in burn patients has been effectively performed in nine eyebrows in six burn patients. The results were excellent in seven of the eyebrows and satisfactory in the remaining two. In the authors' experience, the free hair transplants have had marginal results because of the scarred recipient site, and we recommend the island pedicle graft as an alternative, in selected cases, for facial burn reconstruction. Case summaries, details of the operative procedure, and illustrations are presented.

Adolescent↗

Reconstruction of the eyebrow in the pediatric burn patient.

We have reviewed our experience with reconstruction of eyebrow alopecia secondary to thermal injury in the pediatric patient. Reconstruction was performed with free composite strip grafts or vascularized island pedicle flaps. The complication rates for eyebrows reconstructed with vascularized island pedicles with respect to loss of a significant portion of the flaps (30.8 percent) and malalignment of the grafts (23.1 percent) were significantly greater (p less than 0.001) than the significant tissue loss (10.6 percent) or graft malalignment (7.9 percent) observed for free composite grafts. Hair density was more predictably restored with the free composite graft technique (p = 0.0004). The patients reconstructed with composite grafts had 89.4 percent acceptable results in contrast to 38.5 percent acceptable results obtained with the island pedicle technique. Based on these findings, we reserve the use of the vascularized island pedicle technique for male patients with unilateral alopecia and heavy hair density in the remaining eyebrow and in cases where free composite grafts have failed. The remaining patients are initially treated with free composite grafts with acceptable results in the overwhelming majority of cases.

Adolescent↗

Limited-incision forehead lift for eyebrow elevation to enhance upper blepharoplasty.

Treatment of eyebrow ptosis to enhance the cosmetic effect from blepharoplasty is commonly done with a forehead lift using a coronal incision approach. The coronal scalp incision is associated with the annoying sequelae of frontoparietal scalp numbness, itching, and paresthesias, all of which can be permanent. A forehead lift technique with temporal scalp incisions only 4.5 to 5.0 cm in length can produce a result comparable with that of the coronal incision approach when combined with transpalpebral resection of the corrugator supercilii muscles and transection of the procerus muscle. This eyebrow elevation technique, like the endoscopic approach, minimizes the risk of permanently injuring the supraorbital nerve branches that innervate the frontoparietal scalp. Unlike the approach using only endoscopy, however, this technique can effectively treat cases of advanced eyebrow ptosis. The appropriate area of eyelid skin for excision may be difficult to assess when a forehead lift and upper blepharoplasty are done concomitantly. The described forehead lift incorporates a method to determine this area. This forehead lift technique, combined with a technique for protecting against overresecting upper eyelid skin, is described as used effectively on 140 blepharoplasty cases followed for 3 months to 4 years.

Eyebrows↗

Vitiligo koebnerized by eyebrow plucking by threading.

Koebnerization is a well-known phenomenon in diseases like vitiligo and psoriasis. Eyebrow plucking is a common procedure, which induces some trauma. This is a report of a woman with vitiligo whose vitiligo spread to the eyebrow area after eyebrow plucking by threading in a beauty parlour. This is an example of an unusual koebnerization of vitiligo by a very common cosmetic procedure.

Adult↗

Granulomatous dermatitis to iron oxide after permanent pigmentation of the eyebrows.

BACKGROUND: Tattooing with iron oxide pigment is used to create a permanent line along the eyelid margins and to cause permanent pigmentation of the eyebrows. However inflammatory sequelae can occur. OBJECTIVE: To present the development and treatment of a granulomatous inflammation as a sequela of iron oxide tattooing in the eyebrows. METHOD: A skin biopsy was performed, Histopathologic examination revealed deposits of reddish-brown pigment and a superficial dermal infiltrate consisting of lymphocytes and giant multinucleated cells (Langhan's and foreign body). RESULTS: A patient developed a granulomatous reaction to iron oxide after undergoing permanent pigmentation of the eyebrows. Treatment with systemic and topical steroids resulted in marked improvement at 6-month follow-up. CONCLUSIONS: This is an unusual complication. A skin test should be performed on any patient who is to undergo tattooing with iron oxide pigment.

Dermatitis, Contact↗

Complications of eyelash and eyebrow tattooing: reports of 2 cases of pigment fanning.

Eyelash and eyebrow tattooing are commonly performed procedures that have a very low rate of reported complications. We describe one case of infraorbital pigmentation after eyelash tattooing and another of periorbital pigmentation after eyebrow tattooing. Although most complications related to eyelash and eyebrow tattooing, including pigment fanning, have been reported by ophthalmologists, pigment fanning is also of concern to dermatologists.

Adult↗