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.

Fox eyes lift-A new protocol for eyebrow elevation with laser Fotona.

BACKGROUND: The eyelids play an important role in our appearance and are usually the first to show signs of age. The Fotona SP Spectro Systems consist of a range of noninvasive laser treatments that work together synergistically to tighten the collagen in four dimensions and provide long-lasting firmness to the face. The Fotona SP Spectro combines two wavelengths: Er:YAG (2940 nm) and Nd:YAG (1064 nm) with four distinct treatments: SmoothLiftingTM, FRAC3®, PIANO®, and SupErficialTM, allowing safe, painless, noninvasive, and no downtime rejuvenation. AIMS: To present a new protocol of treatment with Fotona SP Spectro for eyebrow elevation, which we call fox eyes lift (FEL), and compare it to the standard SmoothEye® (SE) protocol. METHODS: This is a prospective, interventional, split-face study. The sample consisted of 21 subjects (19 women) with a mean age of 50.1 ± 7.9 years who underwent two different protocols, that is, SE on one side and FEL on the other. The protocol used on each side was selected by drawing lots. Three sessions were held at 1-month intervals. Standardized photographic documentation was obtained before and 30 days after the end of treatment. Eyebrow position before and after complete treatment was quantified using ImageJ software. RESULTS: Statistical analysis by ANOVA showed a significant improvement in eyebrow position after treatment with both protocols, with a significantly greater effect of FEL (p = 0.0003 d = 0.95). CONCLUSION: Fox eyes lift is an efficient and safe technique providing significant improvement in the position of the eyebrow.

Brow Lift Through The Upper Blepharoplasty Incision: Prospective Clinical Study.

BACKGROUND: Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. OBJECTIVE: We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. METHODS: A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software. RESULTS: Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively. CONCLUSION: Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. LEVEL OF EVIDENCE II: 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 .

A quantitative analysis of the brow shape after frontalis muscle contraction.

PURPOSE: To measure the changes of the eyebrow's contour after frontalis muscle (FM) contraction. METHODS: Two consecutive pictures of the eyes and frontal region of 36 volunteers (15 men and 21 women) were obtained with the forehead relaxed and upon maximal frontalis muscle contraction. Bézier lines representing the brows' contours, obtained with the ImageJ software, were graphically sampled with a resolution of 0.025 mm. The contours of the relaxed and elevated brows were compared regarding the position of the contour peak (CP), the degree of elevation of brow central point, and the medial and lateral areas outlined between the brow contours before and after frontalis contraction. The asymmetry of the brow contour after FM contraction was calculated by the Naeije formula as (Medial-Lateral)/(Medial + Lateral). A difference of 10% or less between the lateral and medial areas was taken as a cutoff value for symmetrical brow elevation. RESULTS: In 62 (86.1%) of the eyes, the location of the brow's CP was lateral to the brow's midpoint. When the brows were raised, the CP of 60% of the brows was displaced medially and 40% laterally. The motion of the CP with medial displacement (mean = 3.7 mm) was significantly larger than those displaced laterally (mean = 1.9 mm) decreasing the number of brows with lateral peaks from 62 (86.1%) to 54 (75%). No difference was observed between the mean elevation of the central point of the brow for males (7.9 mm (3.2 SD) and females (7.4 mm, 3.0 SD). In 58.3% of the sample, the positional change of the medial and lateral sectors of the brows was symmetrical, and among the 41.7% asymmetrical cases, the elevation of the medial side was higher than the lateral in 66.7% of the brows. CONCLUSIONS: The brow changes during FM contraction concur well with the anatomic data of the FM shape. The contour of most brows is displaced toward the medial direction when the brow is elevated. The pattern of brow shape change is an indication of the FM anatomy and must be carefully analyzed before any procedure involving the FM, such as chemodenervation injections or frontalis slings for blepharoptosis correction.

Keratosis Pilaris Treatment: Evidence from Intervention Studies.

Keratosis pilaris is a common dermatosis observed in daily dermatologic practice. The diagnosis is clinical and usually asymptomatic, although sometimes patients may complain of mild pruritus and its cosmetic appearance. Few reports exist about its treatment. There are clinical trials assessing topical treatments and laser surgery, but no systematic reviews on its management were found in literature. An online research was conducted to identify evidence-based recommendations. Lactic acid, salicylic acid, and the 1064-nm Nd:YAG laser seem to be the most effective and safe treatment options for keratosis pilaris among patients aged 12 years and older; however, high-quality randomized controlled trials with long-term outcomes are required. (SKINmed. 2022;20:258-271).

Comparison of two techniques for surgical eyebrow suspension.

PURPOSE: Brow ptosis can interfere with blepharoplasty results and can be corrected using several techniques. The present study was performed to compare two techniques for brow suspension, both with concomitant upper eyelid blepharoplasty. METHOD: A prospective, interventional, randomized study involving 27 female patients was performed to compare the effects of two different techniques of brow suspension: eyebrow suspension with nylon thread (ESN) and internal browpexy fixation (IBF), both combined with upper lid blepharoplasty. Qualitative assessment was carried out using a questionnaire, and quantitative angular measurement analysis of the brow position was performed using digital photographs taken with a Vectra H1 camera before, 60, and 120 days after surgery. The data were transferred to an Excel table and statistically analyzed. RESULTS: ESN was performed in 14 patients and IBF in 13 patients. Both groups were homogeneous in terms of age. The main preoperative complaints were excess skin on the upper eyelid (81.4%) and reduced visual field (59.2%) in both groups. Most of the patients expected aesthetic improvement, and the surgical results were considered satisfactory for all of them. There was no significant difference between ESN and IBF in the quantitative evaluation of eyebrow position. CONCLUSION: Both ESN and IBF resulted in a high degree of patient satisfaction. Both techniques provided similar brow suspension, emphasizing that IBF is technically easier to perform and produces less scarring.

Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Isolated hair loss on the eyebrow: five cases with trichoscopic features.

Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.

Aesthetic implications of depressor supercilii muscle block with botulinum toxin type A.

INTRODUCTION: When applying botulinum toxin in the upper third of the face, it is important to consider the balance between the elevator and depressor muscles of the eyebrows. Depressor supercilii muscle block leads to elevation of the medial portion of the eyebrow and correction of the oblique lines in the frown. OBJECTIVES: The intention is to highlight the importance of the depressor supercilii muscle block as a useful tool to reposition the medial portion of the eyebrow. PATIENTS AND METHODS: Three cases are presented, in whom botulinum toxin is applied conventionally and subsequently on the depressor supercilii muscle after the subjective sensation of flattening of the glabella and increasing distance between the eyebrows referred by the patients. RESULTS: The application of botulinum toxin type A on the depressor supercilii muscle is an effective measure to facilitate the elevation of the medial portion of the eyebrow, after the conventional application in between the eyebrows treating the orbicularis, corrugator, and procerus muscles. CONCLUSIONS: Depressor supercilii muscle block can be considered when applying botulinum toxin type A in the upper third of the face, in cases where there is loss of facial aesthetic harmony. This is given by the subjective perspective of the patient due to a change in the natural expression of their face with a sensation of flattening of the glabella and distancing of the medial portion of the eyebrows, occurring after the use of a conventional technique at that anatomical level, where patients may report a "feline" or "avatar" appearance.

Uleritema ofriógenes como entidad asociada al síndrome 18p- en un paciente pediátrico / Ulerythema ophryogenes as an entity associated with 18p- syndrome in a pediatric patient

El uleritema ofriógenes es un trastorno cutáneo benigno y poco frecuente que se presenta habitualmente en la infancia. Se caracteriza por pápulas foliculares eritematosas y queratósicas en el lateral de las cejas, que con el tiempo suelen evolucionar a alopecia cicatricial. Dicha entidad puede aparecer como manifestación clínica aislada o asociada a varios síndromes congénitos (18p-, Cornelia de Lange, Noonan y Rubinstein- Taybi, entre otros). Presentamos el caso de un paciente de 13 años con síndrome 18p- que consultó por lesiones puntiformes rugosas al tacto y pérdida de pelo en ambas cejas (uleritema ofriógenes), así como por hiperqueratosis pilar en brazos. Esta tríada, conocida como síndrome de Zouboulis, ha sido poco descrita en la literatura. Se considera que el reconocimiento del uleritema ofriógenes es de crucial importancia ya que, ante su presencia, debería realizarse una anamnesis y una exploración física exhaustivas en búsqueda de otras alteraciones que pudieran orientar a la existencia de un trastorno genético subyacente.

Ulerythema ophryogenes is a benign and rare skin disorder commonly presenting in childhood. It is characterized by erythematous and keratotic follicular papules located on the side of the eyebrows, and which over time tends to evolve into scarred alopecia. This entity may appear as an isolated clinical manifestation or associated with several congenital syndromes (18p-, Cornelia de Lange, Noonan, Rubinstein-Taybi, among others). We present a 13-year-old male with 18p- syndrome who consults for rough lesions and hair loss in both eyebrows (ulerythema ophryogenes), as well as for hyperkeatosis pilaris in both arms. This triad, known as Zouboulis syndrome, has been rarely reported in the literature. We consider that the recognition of ulerythema ophryogenes is of crucial importance since, in view of its presence, comprehensive anamnesis and physical examination should be performed in search of other alterations that could guide the existence of an underlying genetic disord

[Ulerythema ophryogenes as an entity associated with 18p- syndrome in a pediatric patient]. / Uleritema ofriógenes como entidad asociada al síndrome 18pen un paciente pediátrico.

Ulerythema ophryogenes is a benign and rare skin disorder commonly presenting in childhood. It is characterized by erythematous and keratotic follicular papules located on the side of the eyebrows, and which over time tends to evolve into scarred alopecia. This entity may appear as an isolated clinical manifestation or associated with several congenital syndromes (18p-, Cornelia de Lange, Noonan, Rubinstein- Taybi, among others). Uleritema ofriógenes como entidad asociada al síndrome 18pen un paciente pediátrico Ulerythema ophryogenes as an entity associated with 18p- syndrome in a pediatric patient We present a 13-year-old male with 18p- syndrome who consults for rough lesions and hair loss in both eyebrows (ulerythema ophryogenes), as well as for hyperkeatosis pilaris in both arms. This triad, known as Zouboulis syndrome, has been rarely reported in the literature. We consider that the recognition of ulerythema ophryogenes is of crucial importance since, in view of its presence, comprehensive anamnesis and physical examination should be performed in search of other alterations that could guide the existence of an underlying genetic disorder.

El uleritema ofriógenes es un trastorno cutáneo benigno y poco frecuente que se presenta habitualmente en la infancia. Se caracteriza por pápulas foliculares eritematosas y queratósicas en el lateral de las cejas, que con el tiempo suelen evolucionar a alopecia cicatricial. Dicha entidad puede aparecer como manifestación clínica aislada o asociada a varios síndromes congénitos (18p-, Cornelia de Lange, Noonan y Rubinstein- Taybi, entre otros). Presentamos el caso de un paciente de 13 años con síndrome 18p- que consultó por lesiones puntiformes rugosas al tacto y pérdida de pelo en ambas cejas (uleritema ofriógenes), así como por hiperqueratosis pilar en brazos. Esta tríada, conocida como síndrome de Zouboulis, ha sido poco descrita en la literatura. Se considera que el reconocimiento del uleritema ofriógenes es de crucial importancia ya que, ante su presencia, debería realizarse una anamnesis y una exploración física exhaustivas en búsqueda de otras alteraciones que pudieran orientar a la existencia de un trastorno genético subyacente.

Long-term comparison of the efficacies of internal and external browpexy combined with blepharoplasty / Comparação a longo prazo da eficácia de browpexy interna ou externa associada à blefaroplastia

ABSTRACT Purpose: To perform a long-term comparison of the quantitative efficacy of internal and external browpexy in combination with upper-lid blepharoplasty based on lateral and central eyebrow positions. Methods: This retrospective study evaluated internal and external browpexy with upper-lid blepharoplasty surgeries that were performed during the period between January 2012 and December 2017 in the oculoplastic surgery department of our hospital. Patients who had undergone periorbital and forehead surgery, who had ophthalmologic or neurological diseases, and who were Botox users were not included in the study. Preoperative and postoperative measurements were made on photographs taken in the same position. The distances from the pupil center and from the point of intersection between the horizontal line passing through the pupil and the vertical line passing through the lateral canthus to the upper eyebrow borders were measured. Photogrammetric analysis of eyebrow position was analyzed using Corel Draw software. Results: Preoperative and postoperative photographs of 70 eyelids were analyzed. Measurements were taken 24 months after surgery. Mean elevations of 2.10 and 3.19 mm were observed in the central region and lateral regions, respectively, in the internal browpexy group. These elevations were 2.66 and 3.03 mm in the external browpexy group and 0.48 and 0.55 mm in the control group. Eyebrow elevations in the central and lateral regions were not significantly different from baseline in the control group (p=0.126 and p=0.25). Internal and external browpexy showed statistically similar elevation values in the central and lateral regions (p=0.636 and p=0.342). Conclusions: External and internal browpexy surgery afforded adequate and similar elevations of the central and lateral brow, which were significantly different from those in the standard blepharoplasty group during long-term follow-up.

RESUMO Objetivo: Avaliar a comparação, a longo prazo, da eficácia quantitativa da sobrancelha interna e externa em combinação com a blefaroplastia da pálpebra superior com base nas posições lateral e central da sobrancelha. Métodos: Este estudo retrospectivo avaliou as cirurgias interna e externa da braquiterapia com blefaroplastia de pálpebra superior realizadas entre janeiro de 2012 e dezembro de 2017 no setor de cirurgia Oculoplástica de nosso hospital. Pacientes submetidos à cirurgia periorbitária e frontal, com doenças oftalmológicas ou neurológicas e usuários de Botox não foram incluídos no estudo. Medidas pré e pós-operatórias foram feitas em fotografias tiradas na mesma posição. Foram medidas as distâncias do centro da pupila e do ponto de intersecção entre a linha horizontal que passa pela pupila e a linha vertical que passa pelo canto lateral do olho até as bordas superiores da sobrancelha. A análise fotogramétrica da posição da sobrancelha foi analisada usando o software Corel Draw. Resultados: Foram analisadas fotografias pré e pós-operatórias de 70 pálpebras. As medidas foram feitas 24 meses após a cirurgia. Elevações médias de 2,10 e 3,19 mm foram observadas na região central e laterais, respectivamente, no grupo de sobrancelha interna. Essas elevações foram de 2,66 e 3,03 mm no grupo da sobrancelha externa e 0,48 e 0,55 mm no grupo controle (p=0,126, p=0,25). A sobrancelha interna e externa apresentou valores de elevação estatisticamente semelhantes nas regiões central e lateral (p=0,636, p=0,342). Conclusões: Cirurgia de sobrancelha externa e interna proporcionam elevações adequadas e semelhantes nas sobrancelhas central e lateral que foram significativamente diferentes daqueles no grupo de blefaroplastia padrão no acompanhamento a longo prazo.