Skin-Only Versus Skin-Plus-Orbicularis Resection Blepharoplasty: An Elaborated Analysis of Early- and Long-Term Effects on Corneal Nerves, Meibomian Glands, Dry Eye Parameters, and Eyebrow Position.

PURPOSE: To evaluate the early- and long-term effects of 2 different blepharoplasty techniques on corneal nerves, meibomian gland morphology, clinical parameters of dry eye disease (DED), and eyebrow position. METHODS: This prospective, interventional study included age-sex-matched blepharoplasty patients who had a skin-only resection (24 eyes of 12 patients; Group-S) or a skin-plus-orbicularis muscle resection (24 eyes of 12 patients; Group-M) procedure. Preoperative and postoperative parameters of in vivo corneal confocal microscopy (IVCCM; corneal nerve fiber density [CNFD], nerve branch density [CNBD], and nerve fiber length), meibomian gland area loss (MGAL), DED (Schirmer I test and noninvasive tear breakup time), and eyebrow heights (lateral [LBH] and central [CBH]) were evaluated and compared between the intervention groups ( ClinicalTrials.gov , NCT05528016). RESULTS: Compared with baseline, the CNBD of Group-S (19.91 ± 7.66 vs. 16.05 ± 7.28 branches/mm 2 , p = 0.049) and CNFD of Group-M (19.52 ± 7.45 vs. 16.80 ± 6.95 fibers/mm 2 , p = 0.028) was significantly decreased at postoperative first week. However, in both groups, IVCCM parameters returned to baseline values at postoperative first month and first year ( p > 0.05). A significant MGAL increase was observed in Group-S (18.47 ± 5.43 vs. 19.94 ± 5.31, p = 0.030) and Group-M (18.86 ± 7.06 vs. 20.12 ± 7.01, p = 0.023) at the postoperative first year, demonstrating meibomian gland atrophy. Only significant changes were observed in Group-M in LBH (16.17 ± 2.45 vs. 16.67 ± 2.28 mm, p = 0.044) and CBH (17.33 ± 2.35 vs. 17.96 ± 2.31 mm, p = 0.004) at postoperative first year. CONCLUSIONS: Blepharoplasty with or without orbicularis resection seems to have similar effects on IVCCM, DED, and MGAL parameters. However, incorporating an orbicularis muscle resection in a blepharoplasty operation could slightly elevate the eyebrow position.

Brow Position Change and its Potential Risk Factors Following Upper Blepharoplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Eyebrow position affects human facial expression and aesthetic appearance. However, upper-eyelid surgeries may cause brow position changes and affect the function and aesthetics of the eyebrow. The purpose of this review was to assess the influence of upper-eyelid surgeries on brow position and morphology. METHODS: PubMed, Web of Science, Cochrane Library, and EMBASE were searched for clinical trials and observational studies published between 1992 and 2022. The brow height from the center of the pupil is analyzed to show the brow height change. The change in brow morphology is measured by the change in brow height from the lateral palpebral and the medial palpebral. Studies are further divided into subgroups according to different surgical techniques, author locations, and whether to conduct skin excision. RESULTS: Seventeen studies met the inclusion criteria. Nine studies and 13 groups were included in the meta-analysis, indicating that brow height decreased significantly after upper-eyelid surgeries (MD = 1.45, 95% CI [0.87, 2.07], P < 0.0001), and simple blepharoplasty, double-eyelid surgery, and ptosis correction can cause the brow position to drop by 0.67, 2.52, and 2.10 mm, respectively. East Asian authors group had a significant decrease in brow height compared with the non-East Asian authors group (28 groups, p = 0.001). Skin excision during blepharoplasty does not affect brow height. CONCLUSIONS: Brow position changes significantly following upper blepharoplasty according to the decrease in brow-pupil distance. The morphology of the brow showed no significant postoperative change. Different techniques and authors locations may result in different levels of postoperative brow descent. LEVEL OF EVIDENCE III: 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 .

The Arched Rainbow Brow in Thyroid Eye Disease.

PURPOSE: To morphologically describe and mathematically quantify a novel clinical feature of thyroid eye disease (TED). METHODS: A retrospective study was conducted of TED patients and age-sex-matched normal controls. The arched Rainbow Brow appearance in TED patients was determined by unanimous agreement of 3 oculoplastic surgeons. Eyebrow curvature was assessed by plotting 15 points along the eyebrow in ImageJ. The fourth-degree polynomial ( y = ax4 + bx3 + cx2 + dx + e ) was fitted to each eyebrow. RESULTS: Two hundred seventy-one eyes were analyzed (200 TED and 71 age-sex-matched normal controls). A Rainbow Brow was identified in 42% of TED patients. A unilateral Rainbow Brow was seen in 15% of patients. The fourth-degree polynomial coefficients yielded significant differences between Rainbow Brow patients and age-sex-matched normal controls for the coefficients a, b, c , and d . Similar analysis of TED patients with and without a Rainbow Brow showed differences in coefficients a and b . Age >50 years ( p = 0.009) and the presence of brow fat expansion ( p < 0.001) were associated with the presence of a Rainbow Brow. Proptosis >24 mm showed a trend toward association with the presence of a Rainbow Brow ( p = 0.057). When considering the contribution of these features in a multivariable analysis, only brow fat expansion was a significant contributing factor ( p = 0.009). CONCLUSIONS: The Rainbow Brow is a distinct entity in TED and is likely consequent to brow fat pad expansion. Patients with a Rainbow Brow have different eyebrow curvature as compared to both normal age-sex-matched controls and TED patients without a Rainbow Brow.

Aesthetic ONE21 Technique for Injecting IncobotulinumtoxinA into the Forehead: Initial Experience With 86 Patients.

BACKGROUND: Treatment of upper facial lines is a common aesthetic practice; however, there is limited information on systematic tailored approaches for the treatment of forehead wrinkles using botulinum toxin A. OBJECTIVE: To describe the safety and efficacy of the ONE21 technique using incobotulinumtoxinA (INCO) for the treatment of forehead wrinkles. METHODS: Single-center, retrospective study with 86 females presenting a baseline Merz Aesthetic Scale (MAS) score ≥2 for dynamic forehead lines who had been treated with INCO using the ONE21 technique. Assessment was performed by two independent blinded raters using MAS for forehead lines (dynamic and at rest), and eyebrow positioning, based on standardized pictures taken before (baseline) and 4 (±2) weeks after treatment injection. The primary outcome was the percentage of subjects with a MAS improvement ≥2 points for dynamic forehead lines at week 4 (±2). Secondary outcomes were MAS scores for resting forehead lines and for eyebrow positioning. RESULTS: The mean age was 46.2 years, and mean total dose of INCO, 20.3 U. Most (97.7%) subjects had a MAS improvement of ≥2 points for dynamic forehead lines at week 4 (±2); 100% improved ≥1 point. MAS scores for resting and dynamic lines, and eyebrow positioning were significantly improved (P<0.001). Eyebrow positioning MAS improved ≥1 point in 56.9% of subjects, and 39.5% maintained the original shape. CONCLUSION: INCO injection using the ONE21 technique is effective and safe in treating forehead wrinkles, providing a natural result, with a customized treatment and a predictable eyebrow shape. J Drugs Dermatol. 2021;20(1):31-37. doi:10.36849/JDD.5617.

Photogrammetric Analysis of Eyebrow and Eyelid Dimensions in Indian American Adults.

In cosmetic surgery, knowledge of the average dimensions of periorbital features based on gender and ethnicity is essential to improve the patient appearance and maintain the ethnicity. The aim the study was to establish gender-specific periorbital anthropometric and anthroposcopic data for Indian Americans (IA) and to assess the statistically ethnic differences by comparing with published data of Malaysian Indians (MI). Evaluation of periorbital features was done on the standardized frontal photographs of 400 IA, aged 18 to 26 years. The measured values were evaluated by an independent t-test. Sexual dimorphism was found in all 15 measurements. The eyebrow height, combined height of the orbit and eyebrow, eyebrow apex inclination, apex to lateral canthus distance, medial end of brow to medial canthus distance, lateral end of brow to lateral canthus distance; pretarsal skin height, palpebral fissure height, palpebral fissure inclination (PFI), and medial canthus tilt were significantly greater in female than the males. In males, eyebrow apex hairline distance, apex to lateral limbus distance, eyebrow apex angle (EAA), lower eyelid height, and interpupillary distance was significantly greater than the females. Significant ethnic difference was found between IA and MI for eyebrow height, apex to lateral limbus distance, EAA, palpebral fissure height, and PFI in male group. In female group, EAA, medial canthus tilt, and PFI were significantly greater in MI. Four types of epicanthus were observed and the brow apex between lateral limbus and lateral canthus was the most common position. The generated normative data may be useful during diagnosis and treatment planning.

Three-Dimensional Territory and Depth of the Corrugator Supercilii: Application to Botulinum Neurotoxin Injection.

This study aimed to determine the three-dimensional (3D) territory and depth of the corrugator supercilii muscle (CSM) using a 3D structured-light scanner. Thirty-two hemifaces from Korean and Thai embalmed cadavers were used in this study, and 35 healthy young Korean subjects also participated. A 3D analysis of the CSM territory and depth was performed using a structured-light 3D scanner. The most frequently observed locations of the CSM identified in the cadaver were confirmed in healthy young subjects using a real-time two-dimensional B-mode ultrasonography system. The CSM was present in all of the cadavers and healthy young subjects at the intersection point between the vertical line passing through the medial canthus and the horizontal line passing through the glabella (Point #6). The CSM was located on the medial side of the lateral limbus in most cases. The most-medial and most-lateral origin points were at depths of 5.7 ± 1.4 mm (mean ± SD) and 6.6 ± 1.4 mm, respectively; the corresponding depths of the insertion points were 5.4 ± 1.4 mm and 5.6 ± 2.1 mm, respectively. The origin and insertion points of the CSM were at similar depths. The injection depth should be around 4 mm for botulinum neurotoxin (BoNT) injections into the CSM. Point #6 could be regarded as an effective target point for managing the glabellar frown line and preventing palpebral ptosis when injecting BoNT into the CSM. Clin. Anat., 33:795-803, 2020. © 2019 Wiley Periodicals, Inc.

Anthropometry Analysis of Beautiful Upper Eyelids in Oriental: New Eyelid Crease Ratio and Clinical Application.

BACKGROUND: Beautiful upper eyelids can make one feel more attractive and confident. However, the definition of a beautiful upper eyelid in Orientals is still not defined. The aim of this study was to define the most beautiful upper eyelids in Orientals. METHODS: Participants, who met the inclusion criteria such as Asian ethnic, ages between 18 and 25 years, and double eyelid fold, were conducted. Double upper eyelids were classified into three groups, group A: most beautiful; group B: average; and group C: less beautiful upper eyelid, by plastic surgeons and beauty contestant winners. Eleven linear measurements and type of epicanthal fold were analyzed. RESULTS: A total of 153 participants were included, 66 were male and 87 were female. The mean ages were 21.45 years in males and 21.41 years in the female group. The vertical distances of the palpebral fissure, height of the double fold, height of the lid crease and height of the closed upper eyelid were found to be significantly different between the most, average and less beautiful upper eyelids in both males and females. The type 1 epicanthal fold was the most common in the most beautiful upper eyelid group. CONCLUSION: The most beautiful double upper eyelids in Orientals demonstrated a higher vertical palpebral fissure, double eyelid fold, and height of eyelid crease than the average and the less beautiful double upper eyelids. The ratio of height of lower margin of eyebrow to eyelid crease: Height of eyelid crease is 1.2:1 to create the beautiful double upper eyelids. However, preoperative consultation with realistic expectations is important. LEVEL OF EVIDENCE V: 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.

Reliability of periocular anthropometry using three-dimensional digital stereophotogrammetry.

PURPOSE: Non-invasive three-dimensional (3D) stereophotogrammetry is becoming increasingly popular in many fields. However, few studies have focused on its periocular application. We aimed to provide evidence for the periocular application of a novel anthropometric procedure using 3D stereophotogrammetry by evaluating its reliability. METHODS: Fifty-one Caucasians were recruited (102 eyes; mean age, 31.9 ± 13.6 years). Two sets of 3D images were acquired for each subject, and two measurement sessions were performed on each image by two raters. Fifty-two periocular landmarks were identified, and then 49 corresponding linear, curvilinear, and angular measurements were evaluated for intrarater, interrater, and intramethod reliability. RESULTS: Our findings showed highly reliable results for mean absolute difference (0.59 and 0.68 unit), relative error measurement (2.66% and 3.08%), technical error of measurement (0.59 and 0.66 unit), relative technical error of measurement (2.71% and 2.96%), and intraclass correlation coefficient (0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.94 unit, 4.06%, 0.89 unit, and 3.94%, as well as 0.97 for interrater reliability; and respectively 0.98 unit, 4.66%, 0.96 unit, and 4.64%, as well as 0.96 for intramethod reliability. CONCLUSIONS: This imaging system and the landmark identification protocol are highly reliable. The collected measurements and their errors can be applied for the comparison of reliability among various 3D imaging systems and populations. It could be utilized for planning surgeries and evaluating treatment outcomes for physicians in ophthalmology, plastic and esthetic surgery, and in the maxillofacial field where periocular morphology alterations are made.

Eyebrows cue grandiose narcissism.

OBJECTIVE: Though initially charming and inviting, narcissists often engage in negative interpersonal behaviors. Identifying and avoiding narcissists therefore carries adaptive value. Whereas past research has found that people can judge others' grandiose narcissism from their appearance (including their faces), the cues supporting these judgments require further elucidation. Here, we investigated which facial features underlie perceptions of grandiose narcissism and how they convey that information. METHOD AND RESULTS: In Study 1, we explored the face's features using a variety of manipulations, ultimately finding that accurate judgments of grandiose narcissism particularly depend on a person's eyebrows. In Studies 2A-2C, we identified eyebrow distinctiveness (e.g., thickness, density) as the primary characteristic supporting these judgments. Finally, we confirmed the eyebrows' importance in Studies 3A and 3B by measuring how much perceptions of narcissism changed when swapping narcissists' and non-narcissists' eyebrows between faces. CONCLUSIONS: Together, these data show that distinctive eyebrows reveal narcissists' personality to others, providing a basic understanding of the mechanism through which people can identify narcissistic personality traits with potential application to daily life.

Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology.

PURPOSE: Several anatomical and physio-pathologic studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life. METHODS: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photographs when they were 20, 40, and 60 years old. Then we made comparisons in the group of men (40 people) and in the group of women (40 people) and between men and women. RESULTS: The medial portion of the eyebrow was higher in the photograph taken at 60 years of age than in the one taken at 20 years old in 56.2% of cases; it was higher in 47.5% of cases when comparing the images at 20 and 40. The lateral portion of the eyebrow was seen higher in women in the 20 to 40 group, and it was seen lower in men at 60 years in statistical significance. In more than half of the patients observed, there was not a real descent of the eyebrow and the presence of a more or less accentuated form of upper eyelid's ptosis in the photograph at 60 (globally 47.5%, 55.0% of women and 40.0% of men). This condition was observed in 27.5% of the photographs at 40. There were changes in the horizontal dimension of the palpebral fissure (shortening in 53.7%, preserved in 33.7%, and increased in 12.5% of cases at 60 years old). The position of lateral canthus appeared lower in 40.0% of patients photographed at 60, but it was stable in those photographed at 40. The herniation of the upper eyelid bags was observed in 31.2% of the patients photographed at 60 years old but only in 13.7% at 40. Dermatochalasis of the upper eyelid was present in 67.5% of the people at 60 years old and in 55.0% of those seen when they were 40. Comparing men and women groups 20 to 40, dermatochalasis is more present in men than women at 40 years old with statistical significance. The eyelid-cheek junction was seen to be lower in 75.0% of cases at 60 and in 48.7% of cases at 40, and it is more represented in men than in women. CONCLUSION: We have highlighted some interesting elements, partly agreeing with the data already recorded by other authors', and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures.

Anthropometric Analysis on the Ocular Region Morphology of Children and Young Adults in Chinese Han Population.

PURPOSE: The periocular features vary in different age groups and ethnic populations. In this study, the authors sought to determine whether age-related differences exist for certain periocular parameters between children and young adults of Chinese Han population. METHODS: OU of 310 children (aged 7-10 years) and 301 young adults (aged 20-30 years) were evaluated by 2-dimensional photogrammetry. All the subjects were of Chinese Han population. The eyelid crease profiles were classified according to their morphology. Periocular measurements, including 11 linear and 3 angular parameters were acquired from standardized photographs, 3 indices were further derived. The presence of epicanthal fold was also recorded. Each of the parameters was compared between the age groups. RESULTS: A statistical difference was found between the 2 age groups for the distribution of eyelid crease types. Statistical significances existed between the age groups for various parameters, these include palpebral fissure height and width, margin reflex distance, intercanthal and outercanthal width, distance from the medial end of the eyebrow to the medial canthus, distance from the lateral end of the brow to the lateral canthus, crease height and eyebrow height, angle of endocanthion and exocanthion, palpebral fissure inclination, palpebrae fissure index, canthal index, and angular index (p < 0.05). The incidence of epicanthal fold tended to decrease with increase of age. CONCLUSIONS: Age differences exist in periocular features between children and young adults of Chinese Han population. Standards of periocular measurements based on age and race could provide reliable guidelines for clinical examination and planning periocular surgery.

The Relationship Between Eyebrow and Eyelid Position in Patients With Ptosis, Dermatochalasis and Controls.

PURPOSE: The purpose of this study is to explore mechanical and co-innervational factors involved in both voluntary and involuntary brow elevation among people affected by ptosis and dermatochalasis. METHODS: In this prospective cohort study of normal controls and eyelids with ptosis or dermatochalasis, marginal reflex distance (MRD1) and brow height were measured under the following conditions: neutral position, involuntary mechanical brow elevation, voluntary brow elevation, and maximal eyelid opening. The primary outcome measure was change in MRD1. Secondary outcome measures included brow height and coupling (mm brow height change per mm MRD1 change). Analysis of variance and t tests were performed for intra- and intercondition comparisons, respectively. RESULTS: Mechanical (involuntary) brow elevation significantly raised MRD1 in control eyelids and eyelids with dermatochalasis, but not in eyelids with ptosis. Voluntary brow elevation produced significantly greater brow height than maximal eyelid opening in controls and eyelids with dermatochalasis, but not in eyelids with ptosis. Maximal eyelid opening increased MRD1 greater than voluntary brow elevation significantly in control eyelids, but not in eyelids with dermatochalasis or ptosis. Coupling of the brow and eyelid margin during maximal eyelid opening was significantly greater in eyelids with ptosis relative to controls. CONCLUSIONS: In eyelids with ptosis, mechanical brow elevation does not change eyelid position; however, voluntary brow elevation raises eyelid position to a similar position as maximal eyelid opening. These results argue against the contention that the brow is elevated to mechanically lift the eyelid in ptosis and instead suggest that the brow elevation is driven by efforts to raise the eyelid, possibly via co-innervation.

A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella.

BACKGROUND: Botulinum toxin treatment for forehead wrinkles has been extensively studied and found to be a safe and reproducible procedure. However, the effect on the position of the eyebrows, which relies on the dynamic positioning of the treated muscles, has received less attention and has not been studied with 3-dimensional (3D) technology. OBJECTIVES: The authors sought to evaluate the changes of eyebrow position after standardized botulinum toxin treatment of glabella or glabella and frontalis muscles with 3D imaging. METHODS: In a prospective study, 2 groups of adult females were treated with botulinum toxin A at the glabella only (G) or at the glabella and the frontalis muscle (F/G). The brow position was measured at 5 positions with 3D photography before injection and 2 weeks, 3 months, and 6 months after injection. Results were statistically analyzed and related to patient age. RESULTS: In the F/G group, the brow descended significantly almost across the whole brow length after 2 weeks. The descent lessened after 3 months and moved medially. No clear trend was evident in the G group. There was no significant change attributed to patient age in both groups. CONCLUSIONS: Botulinum toxin treatment of the glabella and frontalis muscle impacts the position and configuration of the eyebrow. The degree of change is affected by the amount of frontalis weakening rather than by treatment of the glabella. While age in general is not a reliable predictor, individual factors play the major role in how pronounced a change of the brow can be expected.

Sensory Innervation of the Upper Eyelid.

The aim of this study was to elucidate the sensory territory of the trigeminal nerve on the upper eyelid.Eight hemifaces from Korean cadavers were dissected. The frontal nerve (FN), supraorbital nerve (SON), supratrochlear nerve (STN), infratrochlear nerve (ITN), and lacrimal nerve (LN) were traced.The terminal branches to the eyelid margin of FN were distributed between 1/6 and 2/5 of the palpebral fissure width lateral to the medial canthus and 1/6 of the eyebrow height from eyelid margin. The SON was distributed between 2/5 and 9/10 of the eye width lateral to the medial canthus, at 1/3 of the eyebrow height. The STN was distributed between -1/4 and -1/5 of the eye width medial to the medial canthus, at 1/5 of the eyebrow height. The ITN was distributed at -1/4 and 1/10 of the eye width medial to the medial canthus, and at 1/5 of the eyebrow height. The LN was distributed between approximately 3/5 and 13/10 of the eye width lateral to the medial canthus, and at 1/4 of the eyebrow height. The main branches of FN and SON ran deep to the orbicularis from the supraorbital notch to the upper border of the tarsal plate. In the pretarsal area, they were between the orbicularis and tarsal plate. The STN and ITN were between the orbicularis and the skin. The LN was observed between the orbicularis and the tarsal plate.Upper eyelid was mainly supplied by SON and FN. The medial extremity was supplied by STN and ITN, and the lateral extremity by LN.

Eyebrow Shapes of Chinese Empresses of the Ming and Qing Dynasties.

The aim of this study was to analyze eyebrow shapes in portraits of Chinese empresses of Ming and Qing dynasties.The frontal portraits of 20 Ming empresses and 24 of Qing in which the eye and eyebrows were identifiable were measured and analyzed. The arch shape did not differ significantly (P > 0.05) between Ming and Qing. The head-up type (66.6%) was significantly more common (P < 0.001), than tail-up (13.6%), horizontal (13.6%), and arched (6.8%). The brow arches of Ming and Qing empresses were classified as 5 arch types: L (Lamas), A (Anastasia), H (Hwang), M (Empress Ma), and D (Empress Du). In Ming, type-H (45.0%) was the most frequent, followed by type-D (25.0%). In Qing, type-L (45.8%) was the most frequent, followed by type-H (16.7%) and type-D (16.7%). The relative eyebrow width (REW) of Ming and Qing was 1.59 ±â€Š0.28. The REW of Qing (1.63 ±â€Š0.30) and Ming (1.55 ±â€Š0.26) did not differ significantly. The relative medial height (RMH, 1.05 ±â€Š0.20) and relative lateral height (RLH; 1.05 ±â€Š0.21) were the same, and greater than the relative mid-pupillary height (RPH; 0.84 ±â€Š0.19; P < 0.001). The RMH of Ming (1.09 ±â€Š0.24) and Qing (1.02 ±â€Š0.16) did not differ significantly. The RLH likewise did not differ significantly between Ming (1.01 ±â€Š0.21) and Qing (1.08 ±â€Š0.22). However, the RPH of Ming (0.91 ±â€Š0.21) was significantly (P = 0.042) greater than Qing (0.79 ±â€Š0.17). The relative brow thickness (RBT) of Qing (0.13 ±â€Š0.06) was significantly (p = 0.033) greater than Ming (0.17 ±â€Š0.06). The RBT of Ming and Qing was 0.15 ±â€Š0.06 and increased with time (P = 0.023).The results of this study may be useful for brow lift or the tattooing.

Eyebrow Position and Shape Favored by Korean Women.

PURPOSE: The shape and position of the eyebrows are among the most important facial features from an esthetic point of view. However, significant cultural differences exist with respect to the eyebrow shape and position that are considered ideal. The purpose of this study was to identify the position and shape of eyebrows preferred by Korean women and to apply these, including forehead lifts, to the clinics. METHODS: The authors took full facial photographs in the Frankfort plane of Korean women aging from young childhood to their 50s. On the basis of these, 2 parameters were calculated: first, the height-to-width ratio (HWR), the ratio between the vertical distance from the brow apex to the palpebral fissure and the horizontal distance from the medial canthus to the lateral canthus; and second, the takeoff angle (TOA), the angle between the straight line connecting the 2 lateral canthi and the line from the brow apex through the center of the medial brow segment. The authors then had drawings of "Anastasia arch" eyebrows made; as high eyebrows are considered beautiful in Korea, and the eyebrows of women in their 20s were the highest, the drawings depicted the mean HWR and TOA values for this age group and their various degrees of deviation. These drawings were shown to 300 women aged 21 to 40 years from May 1 to June 30, 2014; they were instructed to choose the drawing they preferred among the 5 drawings differing in HWR and again among the 5 differing in TOA. RESULTS: Among the 99 Korean women in their 20s, the mean HWR and TOA was 1:1.01 ±â€Š0.23 and 12°â€Š±â€Š5.2°, respectively. Regarding the survey, the most preferred HWR was 1:1.0, which was selected by 204 respondents (68%); the most preferred TOA was 10°, which was chosen by 122 respondents (40.7%). CONCLUSION: This study shows that HWR gradually decreases and TOA increases with age. Furthermore, Korean women's preferred eyebrows have an HWR of ∼1:1 and a TOA of ∼10°. These results could guide plastic surgeons performing periorbital rejuvenation surgeries, including brow lifts, not only for Koreans but also for North-East Asians.

Ideal Facial Relationships and Goals.

Analysis of the face is an essential component of facial plastic surgery. In training, we are taught standards and ideals based on neoclassical models of beauty from Greek and Roman art and architecture. In practice, we encounter a wide range of variation in patient desires and perceptions of beauty. Our goals seem to be ever shifting, yet our education has provided us with a foundation from which to draw ideals of beauty. Plastic surgeons must synthesize classical ideas of beauty with patient desires, cultural nuances, and ethnic considerations all the while maintaining a natural appearance and result. This article gives an overview of classical models of facial proportions and relationships, while also discussing unique ethnic and cultural considerations which may influence the goal for the individual patient.

Surgical and Nonsurgical Techniques in Forehead Rejuvenation.

The periorbital and forehead regions are among the most expressive parts of the face. A thorough understanding of the complex facial anatomy and aesthetic norms are essential when evaluating and treating a patient for facial brow rejuvenation. Not only will knowledge of the anatomy enhance facial injection and surgical outcomes, but will also diminish potential complications. Combining nonsurgical and surgical techniques, including laser and skin rejuvenation, can yield the most natural and effective aesthetic brow improvements.

The Aesthetics of the Upper Face and Brow: Male and Female Differences.

A hallmark of the modern era of facial plastic surgery is the increasing demand for upper facial rejuvenation by both genders and the growing variety of such options, including both surgical and non-surgical modalities. Thus, now more than ever, differentiating these aesthetic ideals between the two genders and understanding their nuances has become a necessity for the facial cosmetics community. In this article, a detailed comparison of the the pertinent anatomical and topographical differences is presented, followed by a review of the historical evolution of these aesthetic trends.

Effect of Orbicularis Muscle Resection during Blepharoplasty on the Position of the Eyebrow.

Dermatochalasis is a skin excess in the upper eyelid which may be associated with either an aesthetic and functional defect, blocking the peripheral vision. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis and to restore youthful contours to the periorbita. It is one of the most commonly performed procedures in aesthetic plastic surgery; however, there is still a lack of consensus about this procedure. The excess skin is sometimes removed alone or in conjunction with a strip of orbicularis oculi muscle. The rationale for both muscle and skin resection or skin alone preserving the muscle is uncertain. Some authors have studied the aging influence in brow position, and a few studies pointed out the influence of the upper blepharoplasty on brow height. The true effects, regarding the position of the eyebrow, of both techniques, with or without resection of the preseptal orbicularis oculi muscle, are unclear. The authors present a review of the literature to find the rationale for resecting or preserving the orbicularis oculi muscle in upper eyelid blepharoplasty and its relation to eyebrow position.