The Gliding Brow Lift: A Systematic Review of the Literature.

INTRODUCTION: Gliding brow lift (GBL) has become one of the most popular techniques for eyebrow lifting in recent years. Despite the widespread use of the technique, there are a few publications in the literature. This systematic review was conducted to present current data on GBL and determine its place among brow lift procedures. METHOD: GBL-related studies were searched in PubMed, Google Scholar, Web of Science, and Scopus databases. The screening was carried out from January 2019 to December 2023. All publications in which GBL was performed alone or in combination with other facial rejuvenation procedures or in which the results related to the technique were included. RESULTS: Sixty-three publications were evaluated, and four met the review criteria. The total number of patients who underwent GBL was 181. Most studies were retrospective case series and had a low level of evidence. It was observed that the evaluation parameters were mostly subjective. The technique was found to be generally effective and had low complication rates. CONCLUSIONS: Although this systematic review shows that GBL is an effective and low-complication technique for a brow lift, there is a need to share prospective, more extensive case series and objective data of patients with longer follow-up periods.

Endoscopic Eyebrow Approach for Aneurysms.

INTRODUCTION: Considerable effort has been made to reduce surgical invasiveness, since Axel Perneczky introduced the supraorbital eyebrow approach as a core part of his keyhole concept in neurosurgery. But a limited approach does not facilitate an already serious and demanding task as aneurysm surgery. In this regard, the enhancement of the visual field before, during, and after microsurgical aneurysm occlusion is a safe and effective method to increase the quality of treatment. Indications/Contraindications: Based on the individual anatomical findings, the supraorbital keyhole approach provides access to most aneurysms of the anterior circulation. The approach is not recommended in large complex aneurysms, giant aneurysms, BA aneurysms located beneath the dorsum sellae, as well as cases of severe subarachnoid hemorrhage (SAH) and expected brain edema. COMPLICATIONS: Experience with endoscopic procedures in aneurysm surgery is limited to several clinical retrospective articles, and no major complications in conjunction with the endoscope were observed. Outcome and Prognosis: The supraorbital eyebrow approach has a low rate of complications and provides highly favorable cosmetic results. Endoscopic inspection prior to clipping might reduce overexposure and mobilization of the aneurysm. It was found that the rate of intraoperative rupture was decreased. The endoscopic post-clipping control helped significantly to reduce aneurysm remnants and unattended parent, branch, or perforator occlusion. CONCLUSION: The supraorbital eyebrow approach is a safe, effective and elegant approach in the treatment of most aneurysms of the anterior circulation. The additional enhancement of the visual field provided by the endoscope before, during, and after microsurgical aneurysm clipping might decrease the rate of intraoperative aneurysm ruptures and unexpected findings concerning aneurysm remnant occlusion and compromise of involved parent, branching, and perforating vessels.

Male Brow Lift and Blepharoplasty.

After reading this article, one should better understand the anatomy of the forehead, brow, and eyelid complexes in the male patient. A thorough history and physical examination allows the facial plastic surgeon to properly select male patients in whom blepharoplasty and brow lift may be indicated. Specific surgical approaches to upper and lower blepharoplasty are discussed in detail. Surgical techniques and indications for each approach to brow lift in men, including direct, midforehead, coronal, pretrichial, endoscopic, temporal, and transblepharoplasty are explicitly outlined.

Comparing clinical measures of near point of convergence and accommodation from the lateral canthus and browline in a paediatric and adolescent population.

PURPOSE: Clinicians measure the near point of convergence (NPC) and the amplitude of accommodation (AA) from the spectacle plane, the bridge of the nose or the lateral canthus when assessing visual function. These values are compared to standard clinical criteria to diagnose vergence and accommodation deficits, despite varying reference points. This prospective study explored measuring relative to the spectacle plane and from the lateral canthus for NPC and monocular AA, and the resulting clinical implications of diagnosing visual deficits. METHODS: Participants were seen by a single clinician for an eye examination. NPC was measured from the forehead and the lateral canthus of the right eye. Monocular AA was measured from the brow and the lateral canthus. Differences between measurements were analysed using non-parametric statistical tests including Wilcoxon Signed Rank, as well as linear regression and a linear mixed effects model to adjust for inter-eye correlation and repeated measures. Chi-square tests were used to assess differences in rates of abnormal findings. RESULTS: Data were collected from 70 participants (53% female, median age 13 [11-15] years). On average, measuring NPC from the lateral canthus yielded a value 1.8 cm higher than measuring from the forehead. Measuring AA from the lateral canthus resulted in an average difference of 1.5 cm compared to measuring from the brow. A total of 39% and 76% of subjects failed NPC compared to clinical norms when measured from the forehead or the lateral canthus, respectively, while 7% and 40% failed AA when measured from the brow or the lateral canthus, respectively. CONCLUSION: With the variable anatomy of the eye, it is imperative to account for the measurement point when assessing visual function. Measuring from the lateral canthus greatly increased the failure rates for NPC and AA compared with measuring from the forehead and brow, respectively.

Eyebrow and Eyelash Loss in Patients With Cancer.

Though it is widely acknowledged that cancer treatments cause hair loss on the scalp, there are limited data on how they affect eyebrow and eyelash hairs. Patients with eyebrow and eyelash loss, or madarosis, seek various treatment options ranging from camouflage techniques with makeup, permanent tattoos, and prescription medications. Though not yet studied in patients with cancer-induced madarosis, techniques such as scalp cooling, cryotherapy, and topical vasoconstrictors are promising preventative options. More robust research is needed to improve both the quality and quantity of available treatment and preventative options. There is a clear need for dermatologists to play a role in supportive oncodermatology for patients who experience eyebrow and eyelash loss secondary to chemotherapy, endocrine therapies, and radiation therapy. J Drugs Dermatol. 2024;23(5):327-331. doi:10.36849/JDD.8003.

Horizontal Gaze Assessment: An Extensive Narrative Review.

OBJECTIVE: Bipedalism was a significant milestone in the evolutionary development of Homo sapiens sapiens, influencing neocortical evolution and subsequent behavioral changes. Coordinated visual and sensory inputs are crucial for posture, environmental interaction, and surgical planning, with horizontal gaze being a pivotal parameter. This narrative review aims to explore various geometric measures used to assess horizontal gaze in patients, highlighting their applications in surgical planning. METHODS: A literature review was conducted in indexed databases using Mesh terms like "Cervical Vertebrae" and "Visual Fields" along with keywords such as "horizontal gaze" and "sagittal spine parameters." Among 477 initially identified articles, 41 were selected for inclusion after rigorous filtering. RESULTS: The most recognized method for assessing horizontal gaze is the Chin Brow Vertical Angle (CBVA), initially described in patients with ankylosing spondylitis. Clinical photography is employed as a tool for CBVA calculation, while other measures like McGregor slope and Slope of the Line of Sight have been considered as alternatives to CBVA. Each method presents its unique advantages and limitations. CONCLUSIONS: This review highlights the need for further research into horizontal gaze measurement methods. Developing novel approaches to determine horizontal gaze can significantly enhance surgical planning and, consequently, improve patient outcomes. The ongoing exploration of these geometric measures offers promising prospects for advancing the field and optimizing patient care.

Dual-plane lift-and-hold technique for brow ptosis in young patients with facial paralysis.

BACKGROUND: Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. METHODS: Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. RESULTS: The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. CONCLUSIONS: Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.

Keratosis Pilaris-Like Reaction Associated With Chromatin Remodeling Complex Inhibition in Uveal Melanoma.

This case series describes a constellation of novel adverse reactions in 3 of 9 patients with uveal melanoma receiving treatment targeting activity of the Brahma-associated factor chromatin remodeling complex.

Dermatological manifestations in Costello syndrome: A prospective multicentric study of 31 HRAS-positive variant patients.

BACKGROUND: Data on dermatological manifestations of Costello syndrome (CS) remain heterogeneous and lack in validated description. OBJECTIVES: To describe the dermatological manifestations of CS; compare them with the literature findings; assess those discriminating CS from other RASopathies, including cardiofaciocutaneous syndrome (CFCS) and the main types of Noonan syndrome (NS); and test for dermatological phenotype-genotype correlations. METHODS: We performed a 10-year, large, prospective, multicentric, collaborative dermatological and genetic study. RESULTS: Thirty-one patients were enrolled. Hair abnormalities were ubiquitous, including wavy or curly hair and excessive eyebrows, respectively in 68% and 56%. Acral excessive skin (AES), papillomas and keratotic papules (PKP), acanthosis nigricans (AN), palmoplantar hyperkeratosis (PPHK) and 'cobblestone' papillomatous papules of the upper lip (CPPUL), were noted respectively in 84%, 61%, 65%, 55% and 32%. Excessive eyebrows, PKP, AN, CCPUL and AES best differentiated CS from CFCS and NS. Multiple melanocytic naevi (>50) may constitute a new marker of attenuated CS associated with intragenic duplication in HRAS. Oral acitretin may be highly beneficial for therapeutic management of PPHK. No significant dermatological phenotype-genotype correlation was determined between patients with and without HRAS c.34G>A (p.G12S). CONCLUSIONS AND RELEVANCE: This validated phenotypic characterization of a large number of patients with CS will allow future researchers to make a positive diagnosis, and to differentiate CS from CFCS and NS.

Clinical outcomes and complications of eyelid versus eyebrow approaches to supraorbital craniotomy: systematic review and indirect meta-analysis.

OBJECTIVE: Eyebrow supraorbital craniotomy is a versatile keyhole technique for treating intracranial pathologies. The eyelid supraorbital approach, an alternative approach to an eyebrow supraorbital craniotomy, has not been widely adopted among most neurosurgeons. The purpose of this systematic review and meta-analysis was to perform a pooled analysis of the complications of eyebrow or eyelid approaches for the treatment of aneurysms, meningiomas, and orbital tumors. METHODS: A systematic review of the literature in the PubMed, Embase, and Cochrane Review databases was conducted for identifying relevant literature using keywords such as "supraorbital," "eyelid," "eyebrow," "tumor," and "aneurysm." Eyebrow supraorbital craniotomies with or without orbitotomies and eyelid supraorbital craniotomies with orbitotomies for the treatment of orbital tumors, intracranial meningiomas, and aneurysms were selected. The primary outcomes were overall complications, cosmetic complications, and residual aneurysms and tumors. Secondary outcomes included five complication domains: orbital, wound-related, scalp or facial, neurological, and other complications. RESULTS: One hundred three articles were included in the synthesis. The pooled numbers of patients in the eyebrow and eyelid groups were 4689 and 358, respectively. No differences were found in overall complications or cosmetic complications between the eyebrow and eyelid groups. The proportion of residuals in the eyelid group (11.21%, effect size [ES] 0.26, 95% CI 0.12-0.41) was significantly higher (p < 0.05) than that in the eyebrow group (6.17%, ES 0.10, 95% CI 0.08-0.13). A subgroup analysis demonstrated significantly higher incidences of orbital, wound-related, and scalp or facial complications in the eyelid group (p < 0.05), but higher other complications in the eyebrow group. Performing an orbitotomy substantially increased the complication risk. CONCLUSIONS: This is the first meta-analysis that quantitatively compared complications of eyebrow versus eyelid approaches to supraorbital craniotomy. This study found similar overall complication rates but higher rates of selected complication domains in the eyelid group. The literature is limited by a high degree of variability in the reported outcomes.

A Biological Approach to Periorbital Aesthetics in Caucasian Females: A Review of the Literature.

The face plays an important role in human interactions, and the periorbital region is particularly important for recognition and attractiveness. There are several studies on the beauty of the periorbital region with a variety of methodologies, but few articles consider the attractiveness factors derived from evolutionary psychology such as symmetry, dimorphism, age and average, neoteny, and facial expression. The aim of this study was to identify periorbital attractiveness criteria in Caucasian females based on experimental studies and to interpret them in the light of studies on biological attractiveness factors. A review of literature was conducted with PubMed, the Cochrane Library Database, and EMBASE. Studies published after March 20, 2022, were analyzed, and no date limit was applied to reference papers. The search strategy was focused on 3 main concepts: attractiveness AND evaluation AND facial feature of periorbital region. A total of 780 articles were identified with this search strategy; 534 were excluded based on title and abstract and another 110 after full text assessment. Eighteen articles were finally included in the analysis. The main factors identified were an ascending intercanthal axis and eyebrow axis, a regular pretarsal plate and a well-defined upper lid crease, no scleral show, and an open eye fissure exposing the upper half of the iris. In our review we were able to identify objective anthropometric characteristics linked to biological attractiveness criteria that may be helpful in preoperative planning and assessment of the periorbital region of patients.

Fully Endoscopic Minimally Invasive Trans-Eyebrow Supraorbital Translaminar Approach to Third Ventricle Craniopharyngiomas: Technical Nuances and Stepwise Illustrative Description.

BACKGROUND: Traditional microsurgical approaches for addressing intraventricular craniopharyngioma provide limited access to the retrochiasmatic area and tumors with significant lateral or rostrocaudal extensions. Extended endoscopic endonasal approaches can effectively overcome many of limitations, yet they require a favorable working angle between the optic chiasm and pituitary gland, as well as the involvement of the third ventricle floor by the tumor. METHODS: Herein, the authors describe the surgical nuances of a keyhole technique for resecting third ventricle craniopharyngiomas via a fully endoscopic minimally invasive trans-eyebrow supraorbital translaminar approach (ESOTLA). A case description detailing the key surgical steps and application of the approach is provided, along with a series of cadaveric photographs to highlight the relevant anatomy and step-by-step dissection process. RESULTS: The patient is a 44-year-old man who presented with polyuria, low urine specific gravity, and panhypopituitarism. Brain magnetic resonance imaging revealed a solid-cystic heterogeneous-enhanced retrochiasmatic mass within the third ventricle, consistent with craniopharyngioma. A 1-stage ESOTLA was indicated based on the narrow pituitary-chiasm angle and the high functional status of the patient. Near-total resection was achieved, and no new postoperative neurologic or endocrine change was observed. Targeted therapy was implemented based on the histologic result, and the most recent surveillance magnetic resonance imaging showed no evidence of the residual tumor. CONCLUSIONS: By combining a keyhole approach with variable-angle endoscopic visualization through a smaller bony and soft tissue exposure, ESOTLA can provide enhanced illumination within the third ventricle, potentially addressing cosmetic concerns and limited exposure area/angle of freedom associated with its conventional microsurgical counterpart.

Eyebrow trichoscopy in leprosy.

BACKGROUND: Trichoscopy is a noninvasive technique based on the analysis of hair structures and the scalp, which allows for early diagnosis of different forms of alopecia. METHODS: We conducted a descriptive cross-sectional study in the Dermatology Department of Hospital Universitario "Dr. José Eleuterio González" in Monterrey, Northeastern Mexico. We included 25 patients with a confirmed diagnosis of leprosy. Ten dermoscopic characteristics were assessed in the eyebrows of these patients. Images of the medial and distal portions of the eyebrows were included. Cohen's kappa coefficient was used for the analysis of coherence between the findings of two dermatologists. RESULTS: Of the 25 patients, 14 were male (56%) and 11 were female (44%), with a median age of 60.28 years (IQR: 40-87). The most common findings in the medial eyebrow included vellus hair (96%) and white-yellowish structureless areas (84%). Furthermore, the most common features of the distal eyebrow included vellus hair (96%), white yellowish structureless areas (92%), and pinpoint white dots (92%). CONCLUSIONS: To the best of our knowledge, this study is the first of its kind to describe trichoscopy findings in different leprosy subtypes and classify them into medial and distal eyebrow findings, which seem to be the most affected areas. Identification of these changes is easier in the distal portion of the eyebrows in every subtype of leprosy. We also discovered new trichoscopic findings in the eyebrows: perifollicular hyperpigmentation and yellow dots.