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2009 Annual Meeting Abstracts

Changes in Eyebrow Position and Shape with Aging
Evan Matros, MD1, Jesus A. Garcia, MD, PHD1, Michael J. Yaremchuk, MD2.
1Harvard, Boston, MA, USA, 2Harvard, Massachusetts General Hospital, Boston, MA, USA.

Browlift operations are performed to rejuvenate the upper third of the face. However, there is no scientific or normative data to define the appearance of young and old brows. The lack of an objective goal for browlift surgery may explain why several articles in the plastic surgery literature concluded that both conventional open and endoscopic browlift procedures frequently produce brows with shape and position which are not aesthetically pleasing. This study provides objective data to compare brow shape and position in both young and mature women.
Two random cohorts of women ages 20-30 and 50-60 were photographed upright with the head in neutral position. Images included a metric ruler taped to the forehead. Eyebrow position was determined by measuring from a horizontal plane between the medial canthi to vertical points on the upper brow margin at the medial, mid and lateral brows. Women were excluded if they had previous periorbital/forehead surgery, plucked the upper eyebrow margin, or used botulinum toxin. Standard statistical analyses were used to compare groups.
The upper eyebrow in the 20-30 year old group (n=36) measured 15.7 mm, 19.8 mm and 21.3 mm above the medial canthus, pupil, and lateral canthus respectively. The lateral brow position was significantly higher than the mid-brow (p<.05). In the 50-60 year old group (n=34) the upper brow measured 19.1mm, 22.4 mm and 22.4 mm above the medial canthus, pupil, and lateral canthus respectively. At all three points measured, the brow was at a higher position in the older compared to the younger subjects. This difference was statistically significant at the medial and mid-brow positions (p<.05).
Unlike other areas of the body where there is relative descent of soft tissues, there is, on average, a paradoxical elevation of the eyebrow with aging in women. The apex lateral contour of the youthful brow is transformed into a flattened brow (apex neutral) over time. These findings explain why current browlift procedures may fail to achieve the aesthetic ideal and provide a rationale for lowering previously surgically elevated brows. When aiming to rejuvenate the forehead region, techniques that selectively elevate the lateral brow while restoring the normal balance of muscular forces to the medial brow should be considered.


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