Background: Reduction or augmentation of the brow bones is typically thought of as a horizontal change in their prominence. Such movements create more or less of a brow bone prominence most easily seen and appreciated in a lateral or side view. Such degrees of horizontal brow bone prominence is very gender-specific and is the motivation for much of aesthetic brow bone surgery.
One dimension of the brow bone or supraorbital rims that is rarely discussed is that of its lower edge. This dimension of the tail of the brow bone has an influence on eye shape affecting the position of the eyebrow and the fullness of the supratarsal fold. Eye asymmetry can result from differences in the position of the lateral brow bone edge. Low bony rims can also close down the eye and make contribute to upper eyelid heaviness/fullness.
The anatomy of the lateral brow bone is very simple. In this area of the brow bone there is no frontal sinus and the bone is very thick before entering the intracranial space. The only piece of relevant anatomy is that of the lacrimal gland. It is just under the tail of the brow bone in the lacrimal fossa.
Case Study: This 56 year old female had lifelong eye asymmetry. Her right upper eyelid was fuller than that of the left and she felt that the bone was pressing down on the eyelid. By feel the tail of the brow bone on the right side was lower.
Under general anesthesia, an upper blepharoplasty incision was made and dissection done under the orbicularis muscle up to the outer brow bone. The soft tissues were elevated and 5mms of the lower edge of the tail of the brow bone was removed with a handpiece and burr in a 9 to 1:00 o’clock span. The superolateral orbital soft tissues were suspended back up to the periosteum on the anterior face of the brow bone.
Her results show improved eye symmetry with a more open upper outer area of the right eye. She has no numbness or motion difficulties with the eyelid during blinking. The blepharoplasty incision healed imperceptibly.
The lower edge of the outer brow bone can be contoured/vertically reduced to create a more open eye or correct eye asymmetry. It is safe, causes no orbicularis muscle motion problems and can be done through the well known upper blepharoplasty incision.
1) Brow bone reduction can be done on the inferior outer edge for brow asymmetry or to open up the outer aspect of the upper eye.
2) Inferior brow bone reduction can be done through an upper blepharoplasty incision.
3) Resuspension of the stripped soft tissues is important when reducing the lower edge of the supraorbital rim.
Dr. Barry Eppley