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A diverse variety of methods for reconstructing eyebrow defects has been described previously, and each procedure has inherent advantages and disadvantages. The authors present a case of reconstruction of a partial eyebrow defect using two eyebrow island flaps, which are modifications of the subcutaneous pedicle flap.
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The development of eyebrow ptosis with aging is commonly attributed to progressive laxity of scalp and forehead soft tissues. If the change in eyebrow position with aging resulted entirely from this basic mechanism of tissue stretching, uniform lowering of the medial and lateral eyebrow segments should occur. Clinical observations show, however, that the lateral eyebrow segment usually becomes ptotic earlier than the medial segment, indicating that a more complex mechanism exists. To clarify this process, anatomic studies were done on 20 (40 half-head) fresh cadaver specimens. Histologic studies also were performed to complement the gross anatomic findings. These studies confirm that the mechanism producing eyebrow ptosis has a relatively greater effect on the lateral eyebrow segment. The lateral eyebrow has less support from deeper structures than the medial eyebrow, and the balance of forces acting on the eyebrow selectively depresses the lateral segment. Structures that may promote mobility and gravitational descent of the eyebrow, especially the lateral eyebrow segment, are (1) the galea fat pad, (2) the preseptal fat pad, and (3) the subgalea fat pad glide plane space. Three forces that act on the lateral eyebrow are (1) frontalis muscle resting tone, which suspends that eyebrow segment medial to the temporal fusion line of the skull, (2) gravity, which causes the soft-tissue mass lateral to the temporal line to slide over the temporalis fascia plane and push the lateral eyebrow segment downward, and (3) corrugator supercilii muscle hyperactivity in conjunction with action of the lateral orbicularis oculi muscle, which can antagonize frontalis muscle activity and directly facilitate descent of the lateral eyebrow. The axis point for these forces is the temporal fusion line of the skull near the superior orbital rim. The interaction of those structures and forces contributing to the mechanism producing eyebrow ptosis is discussed. Derived concepts are applied to the execution of the forehead lift procedure.
This study correlates brow lift outcomes published in the plastic surgical literature with aesthetic criteria for ideal female eyebrow height and shape. Aesthetic criteria were determined by testing the opinions of 11 cosmetic surgeons and 9 cosmetologists. Eyebrow height and shape were altered with computer graphics to isolate those changes as the only variables of appearance. Plastic surgeons and cosmetologists preferred (p = 0.01) medial eyebrows below or at the supraorbital rim and disliked the medial eyebrow above the rim. Both groups preferred (p = 0.01) eyebrow shape to have an apex lateral slant. One hundred preoperative and 100 postoperative photographs from 16 frequently referenced articles on brow lifts were evaluated. There was a significant (p = 0.0008) increase in the number of medial eyebrows elevated above the rim. The number of medial apex eyebrows increased, and the number of flat brows decreased (p = 0.01). There was no significant increase in the number of apex lateral eyebrows. Three conclusions are made about female eyebrows: (1) The medial eyebrow should be located at or below the supraorbital rim but not above it. (2) Eyebrow shape should have an apex lateral slant. (3) Standard open and endoscopic brow lift operations frequently result in unsatisfactory eyebrow height and shape, judged by these criteria.
BACKGROUND: Reconstruction of the eyebrow has historically been accomplished with temporal scalp pedicle flap formation or free composite scalp grafts. These two techniques may be associated with substantial morbidity and a false, overly dense eyebrow appearance. Hair transplantation of the eyebrows has been described with excellent results, but is relatively underreported in the literature. OBJECTIVE: To determine whether modern techniques of micrograft hair transplantation can suitably re-create an aesthetic eyebrow in a case of iatrogenic eyebrow alopecia. METHODS: A 33-year-old woman with iatrogenic eyebrow alopecia underwent four sessions of eyebrow micrograft hair transplantation to re-create both eyebrows. RESULTS: Suitable aesthetic eyebrows were re-created in a symmetric fashion with proper hair orientation. The process was time consuming and tedious, but highly effective. CONCLUSION: Eyebrow transplantation is a suitable alternative to pedicle flap formation and composite scalp grafting. It is a straightforward procedure that can be performed in the office under local anesthesia with minimal attendant morbidity. The result may be superior to that seen with more involved eyebrow replacement procedures.
An anatomical study was performed to gain a better understanding of the pathogenesis of eyebrow ptosis. Through cadaver dissection, we sought to establish the anatomy of the normal eyebrow, to determine why the temporal part of the eyebrow becomes ptotic earlier than the medial portion, and to locate precisely the regional nerves and vessels to aid the eyebrow surgeon. a fat-pad exists beneath the eyebrow. Dense attachments on the underside of the eyebrow fat-pad secure the eyebrow to the supraorbital ridge. Because the supraorbital ridge extends only over the medial one half to two thirds of the orbit, the lateral part of the eyebrow lacks deep support and droops with the frontal skin and muscle relaxation seen in age. Vertical lateral orbicularis fibers are consistently seen in the cadaver. Because of their location, they may play a role in producing "laugh lines."
Involvement of the eyebrow fat pad in Graves' disease has never been reported. We noted that Graves' orbitopathy patients had bulkier eyebrows due to a larger eyebrow fat pad not associated with the preaponeurotic fat. A cadaver model was used to show that the eyebrow fat could be identified with magnetic resonance imaging (MRI) scans. Then, a series of Graves' orbitopathy patients were sent for orbital MRI scans, and the eyebrow fat was measured with maximum lengths and widths. The averages were compared to two groups of patients, one without orbital pathology, and one with orbital pathology causing proptosis but not due to Graves' disease. Graves' patients with early orbitopathy and incipient optic neuropathy or congestive orbits where optic neuropathy had to be ruled out had statistically significant larger eyebrow fat pads than either comparison group. This has clinical significance: The eyebrow fat may need to be debulked during operations such as blepharoplasty. Furthermore, periorbital fat may play a larger role in the disease process than previously thought.
OBJECTIVE: To determine if upper eyelid blepharoplasty causes eyebrow position to drop in a cosmetic surgery population. DESIGN: Retrospective, observational study. A treatment group that underwent upper eyelid blepharoplasty was compared with a matched control group that did not undergo the surgery. SETTING: Private facial plastic surgery practice. All surgery was performed at an ambulatory surgical facility on an outpatient basis. PATIENTS: A total of 82 patients (164 eyes) were included in this study: 54 (8 men and 46 women; average age, 46.8 years) in the treatment group and 28 (6 men and 22 women; average age, 43.8 years) in the control group. The treatment group was chosen in a retrospective fashion to include only those patients (1) for whom preoperative and postoperative photographs were available and (2) who had undergone upper eyelid blepharoplasty by the senior author (F.M.K). These patients underwent no other procedures, either before or during the time span between the photographs, that could affect eyebrow position. The control group consisted of patients who had an available set of matching photographs taken over time. These patients did not undergo blepharoplasty or any other procedure that could alter eyebrow position between their initial and final photographs. INTERVENTION: Upper eyelid blepharoplasty performed by the senior surgeon (F.M.K.). The surgical technique was identical in all cases. OUTCOME MEASURE: The change in eyebrow height reflected as a percentage of the pretreatment height. Results are based on measurements taken from standardized photographs. RESULTS: Original treatment and control groups of 108 and 56 eyes, respectively, were restricted to a smaller number to create similar populations for comparison. Therefore, 40 eyes in the treatment group were matched with 28 eyes in the control group to control for the duration between measurements. A t test found no significant difference (P = .94) in eyebrow height between patients who had a blepharoplasty and those who had not. CONCLUSION: In a cosmetic surgery population, upper eyelid blepharoplasty does not cause a lowering of the eyebrow.
Facial appearance is influenced by the anatomic relationship of the eyebrow and eyelid, and surgical procedures on these structures attempt to restore or preserve not only symmetry but also normal appearance. To provide useful benchmarks for such interventions, we measured the eyebrow height, upper eyelid crease height, and amount of visible pretarsal skin of 143 white subjects who had no facial abnormalities. An age effect was observed for all measures, indicating a direct relationship with age until the middle age range (41 to 60 years), when mean estimates leveled off or decreased somewhat relative to younger age groups. Within the 41- to 60-year age group, for example, the average (S.D.) values for pretarsal skin height, eyelid crease height, and eyebrow height were 1.4 mm (1.1 mm), 6.4 mm (1.2 mm), and 6.4 mm (1.8 mm), respectively. Eyebrow and pretarsal skin heights were greater in females than males, and eyelid crease height showed similar gender-related trends. With increasing age, variation around the mean estimates for eyelid and eyebrow measurement increased, which may be indicative of variability across individuals in the physiologic response to the aging process. As expected, a high degree of intereye correlation was observed (correlation coefficients of 0.87 to 0.96). These results emphasize the importance of providing a normal anatomic relationship that relates to the patient's age and gender, as well as an outcome that is symmetric, in corrective or cosmetic procedures on the eyelid and eyebrow.
The contribution of the eyebrow component (eyebrow density and eyebrow position) in interpretation of facial displays of emotions was explored. In Study 1, college students (N = 60) and children (N = 60), ages 6-9 years, listened to vignettes consisting of one or two sentences and selected the facial expression that best matched the vignette. A main effect for eyebrow density as well as interactions for Density x Age and Density x Emotion were found. Also, a main effect for eyebrow position and interactions for Position x Age, Position x Emotion, and Position x Age x Emotion were significant. Study 2 was conducted to better understand whether findings regarding eyebrow position were a function of mistaking the intended emotion portrayed in the vignettes. Using a within-subject design, responses from 60 children, age 6-9 years, were compared for trials when the emotion was designated and when emotion was not designated. A main effect for designation of emotion was not found; however, an interaction effect for Designation x Emotion was significant.
The peripheral lymphocyte cultures from Rhesus monkeys (Macaca mulatta), White-eyebrow gibbons (Hylobates hoolock) and human being were treated with BrdU (bromodeoxyuridine), FrdU (fluorodeoxyuridine) and MTX (methotrexate). A number of 22 Common fragile sites for Rhesus monkeys and 20 for white-eyebrow gibbons were found. Chromosome homology and the relationship between fragile sites and chromosomal evolution were discussed. Several common fragile sites of human chromosomes have been found at the homologous chromosomal regions in Rhesus monkeys as well as in White-eyebrow gibbons. Furthermore, the fragile sites at 1q14, 1p32 of Rhesus monkey chromosomes may correspond to the homologous fragile sites at 1p21, 1q31 of White-eyebrow gibbons. All of these fragile sites at the homologous regions of chromosomes are evolutionarily conserved and may be the indicators of common origin of chromosomes as genetic markers. Combined with G-banding patterns of chromosomes, the conservative fragile sites at homologous regions of chromosomes may be useful for the study of chromosome homology and evolution in closely-related animals. Out results show that the differences of chromosome 1 between Rhesus monkeys and human may involve a pericentric inversion and a paracentric inversion. However, the differences of chromosome 1 between Rhesus monkeys and White-eyebrow gibbons may caused by a pericentric inversion, a pericentric inversion, and a deletion or a translocation. The main differences of chromosome 3 between Rhesus monkeys and human may involve a pericentric inversion. Out results indicate that the differences of chromosome 7 between White-eyebrow gibbons and human may involve a paracentric inversion.(ABSTRACT TRUNCATED AT 250 WORDS)
Netherton's syndrome is a rare autosomal recessive condition with variable expression. It comprises an ichthyosiform dermatitis and erythroderma of variable intensity and manifestations, associated with hair abnormalities. The pathognomonic finding (required for diagnosis) is that of trichorrhexis invaginata identified by light and scanning electron microscopic examination of hair shafts. This may be difficult to establish because the hair is sparse and not all hairs exhibit abnormalities. In one patient, cutaneous and hair problems had existed since infancy, and despite repeated examination of scalp hairs, the definitive diagnosis was made only by examining eyebrow hairs at the age of 30 years. We subsequently compared the number of diagnostic lesions found on scalp and eyebrow hairs from two other patients with previously diagnosed Netherton's syndrome. The density of lesions was greater in eyebrow than scalp hair, and furthermore, all eyebrow hairs had at least one lesion. It is proposed that microscopic examination, if possible, of both scalp and eyebrow hair from patients in whom Netherton's syndrome is suspected would increase the chance of a positive diagnosis.
Fifteen patients and 28 eyes with measurable eyebrow ptosis underwent standard upper eyelid blepharoplasty with or without sub-brow fat excision. The patients were educated about the status of their eyebrow position and the effects of either direct or indirect methods of brow elevation. The patients either refused or chose not to undergo browpexy by any method. Eleven patients and 22 eyes showed an insignificant change in their eyebrow position after surgery. Two patients and three eyes had a mild to moderate descent of the eyebrow and two patients had what was felt to be significant worsening of their eyebrow ptosis in one or both eyes. However, all were pleased with their result. Information as such, after a careful review of the literature, has not previously been published.
OBJECTIVE: To describe the prenatal diagnosis of trichothiodystrophy (TTD) through endoscopically-guided fetal eyebrow biopsy. MATERIALS AND METHODS: A 32-year-old patient, gravida 4, para 3, with a history of 2 previous infants affected with TTD was referred at 17(5)/(7) weeks for fetal hair biopsy. DNA repair studies had been normal in the previous children. Four 1-mm biopsies were obtained from the external aspect of the fetal eyebrows under direct endoscopic guidance. Fetal hair samples were assessed with polarized microscopy, electron microscopy, hematoxylin and eosin staining, and were also sent for analysis of sulfur content (cystine levels). RESULTS: The fetal eyebrows were the only adequate source of hair in the early second trimester. The biopsy samples yielded adequate material for all tests. Polarized microscopy showed characteristic banding patterns, but trichoschisis was not apparent. Cystine levels (19 micromol/l) in the biopsy sample were significantly lower than an age-matched (fresh spontaneous abortion) control (368 micromol/l). CONCLUSION: Prenatal diagnosis of TTD is possible in the second trimester through endoscopically-guided eyebrow biopsy. An adequate amount of hair is present in the eyebrows by then, and the disease is already manifest. Analysis of sulfur content of the hair samples is preferred over polarized or electron microscopy, as many classic microscopic findings of TTD may not be present in the early second trimester.
The aging process in the human face most often is first visible in the temporal-orbital region, where the ptosis of the eyebrow edge and pseudoexcess of upper eyelid skin are caused by orbicularis oculi muscle downfall. Through the upper blepharoplasty standard incision, the orbicularis oculi muscle is mobilized widely and suspended into a higher position with a stitch put on the deep temporal fascia. In this way the eyebrow is elevated and stabilized, thus reducing so-called "crow's feet." In some cases, when the skin distance between the temporal hairline and the eyebrow edge is too short or when it is necessary to lift the eyebrow edge more than 3 mm, a supplementary temporal incision is recommended to tighten better, in the same direction as the tension vector, the superficial temporal fascia and the overlying skin, firmly bonded to it.
The authors review their experience in the surgery of intracranial aneurysms via an eyebrow keyhole approach. The eyebrow keyhole approach presumes a skin incision in the lateral two-thirds of the eyebrow followed by small supraorbital craniotomy (15 x 25 mm). Using this approach and an intraoperative endoscope for better visualisation of the aneurysmal neck, the authors operated on thirty-seven patients with forty intracranial aneurysms. There was no mortality, postoperative recovery was fast, and the cosmetic effect was excellent. Advantages and possibilities of this approach are discussed and results are presented. The authors recommend this approach as a minimal invasive surgery procedure in the treatment of intracranial aneurysms. When performed by experienced vascular neurosurgeons this approach is neither more difficult for the surgeon nor more dangerous for the patient than any other standard craniotomy procedure. According to the authors' present results, surgery of intracranial aneurysm via an eyebrow keyhole approach is the method of choice when performed by an experienced vascular neurosurgeon.
Five cases of partial eyebrow reconstruction using subcutaneous pedicle flaps from the ipsilateral eyebrow are presented. Proper use of this method will enable safe one-stage transfer of the skin and the eyebrow hair, preserving the natural hair direction and properties. It will also leave minimal scars and dog-ears. This method is especially suitable for the reconstruction of moderate- to small-sized eyebrow defects.