Background:The eyebrows provide an important framing structure for the eye area. Residing over the brow bones (supraorbital rims) their hairy composition provide an instantly recognizeable facial feature. While eyebrows have very variable shapes and hair features, and they are subject to considerable grooming and modifications based on contemporary style, the one consistent and important feature of them is symmetry.
Asymmetry of the eyebrows is a very noticeable facial feature. Even the slightest amount of eyebrow asymmetry can be detected. It has been shown that as little as 2mms of difference in eyebrow position is noticeable to patients. While some degree of slight eyebrow asymmetry is present in many patients who present for periorbital rejuvenation for example, they can be very effectively treated by Botox injections for improved symmetry and less eyebrow movement. This works because the eyebrows are dynamic and have muscles that can be temporarily blocked or inhibited from moving.
But eyebrow asymmetry that results from nerve paralysis poses a much more challenging problem. The paralyzed eye brow is a fixed structure that is elevated rather than depressed. It can not be made to drop down by Botox injections nor can a surgical release like in a browlift made it become lower. Eyebrow asymmetry from a lower then normal brow position is a much easier to improve as the eyebrow can be raised by a variety of browlifting techniques.
Case Study: This 19 year-old male had surgery as a young child to treat a large forehead lymphangioma. While the lymphangioma was cured, the resective surgery left him with a permanent paralysis of the frontal branch of the facial nerve. This caused the eyebrow to be permanently elevated. The forehead tissues were very scarred and immobile from the prior surgeries.
Under general anesthesia, his left eyebrow was repositioned lower using a classic z-plasty tissue rearrangement technique. The entire tail of the eyebrow was lowered by switching the skin and deeper tissues below it and changing places with it.
At three months after surgery all skin flaps were healed. No loss of amy of the tips of the skin flaps occurred. The eyebrow position was much more symmetrical to the other side albeit not perfectly symmetric.
The overelevated or paralyzed eyebrow is a difficult challenge to reposition as all conventional methods of eyebrow repositioning rely on normal muscle movements and supple forehead tissues. A z-plasty method of reconstruction provides a simple and effective method of eyebrow lowering if the patient is scar tolerant.
Highlights:
1) Symmetry of the eyebrows is an important aesthetic facial feature.
2) An eyebrow that is too high is a much more difficult reconstructive challenge than an eyebrow that is too low.
3) The tail of the eyebrow can be lowered by a traditional z-plasty tissue rearrangement technique.
Dr. Barry Eppley
Indianapolis, Indiana