Attractiveness of eyebrow position and shape in females depends on the age of the beholder

Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review

An increasing number of people are opting for cosmetic surgeries. For many years, the physical and aesthetic appearance of Caucasians has been considered to be ideal. However, it is now commonly acknowledged that attractiveness and aesthetic standards vary among cultural backgrounds and ethnic groups and that Western attractiveness criteria no longer apply to all. Herein, we conducted a comprehensive review of studies that examined cultural and ethnic variations in preferences for facial, breast, and gluteal aesthetics, as well as reviewed studies that investigated ethnic disparities in attitudes and motivations for cosmetic surgery. A total of 4532 references were identified, 66 of which met the inclusion criteria. Several studies have reported that facial golden ratios are invalid for representing perceived attractiveness standards among different ethnicities. The majority of studies also indicated that facial aesthetic interventions should not aim to Westernize but to optimize ethnic traits. Significant ethnic differences in preferences for upper- and lower-pole breast proportions have been reported. The size of the buttocks and waist-to-hip ratio were identified as the main factors of buttock aesthetics, with buttock size preferences having a high ethnic diversity. Interest in cosmetic surgical procedures while maintaining ethnic identity continues to grow among young women worldwide. This comprehensive review strongly suggests that accommodating cultural and ethnic differences in aesthetic standards in cosmetic surgery planning can lead to more acceptable cosmetic outcomes.

Eyebrow Shape Preference Across Age, Gender, and Self-reported Ethnic Group

BACKGROUND

Preference in eyebrow shape has been studied in young women, but less so in older adults, men, and a wide variety of ethnic groups.

OBJECTIVE

To identify preference in eyebrow shape across age groups, genders, and ethnic groups for both the survey responder and the observed subject.

METHODS

Digital images of subjects from 3 age groups (18-39, 40-59, and 60+ years), 2 genders (female and male), and 4 self-identified ethnic backgrounds were edited to correspond to 5 brow shapes (Anastasia, head-up, horizontal, rounded, and tail-up). Panels of images representing the same subject with different brow shapes were displayed and responders ranked them in order of attractiveness via an online survey.

RESULTS

Six hundred fifty-two responders answered the survey. Survey responders generally preferred the Anastasia shape, but not in all subgroups. Strength of preference in eyebrow shape was more marked when observing images of women and less marked when observing men.

CONCLUSION

An arched brow, such as the Anastasia shape, was the preferred eyebrow shape. This study is limited by its survey nature, underrepresentation of self-identified Black study responders, and categorization of data. Despite these findings, the authors advocate determining eyebrow shape preference individually with patients during cosmetic consultations.

Expert Opinion on Non-Surgical Eyebrow Lifting and Shaping Procedures

Eyebrow elevation and reshaping are common concerns that we handle in everyday practice, and we have noticed that the trend is shifting from a medical concern to a cosmetic one. Several eyebrow lift methods are available, both invasive and non-surgical. The method of choice depends on several factors, such as patient expectations and beliefs, financial budget, acceptance of downtime and the available tools in the practice. In this article, we review the recent literature on non-surgical eyebrow lift methods to provide an overview of the current state of this field. We discuss seven different methods for eyebrow lift and reshaping, including botulinum toxin, dermal fillers, fractional radiofrequency, high-intensity focused ultrasound, thermo-mechanical ablation, lasers, and threads. Moreover, we provide practical insight into the procedure, injection techniques, expected results, and patient satisfaction rate.

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.

Shortened Infrabrow Excision Blepharoplasty Combined with the Removal of Orbicularis Oculi Muscle for Dermatochalasis in Asians

The periorbital area tends to be the first and most visible facial part where senility occurs and therefore is of great concern. Various blepharoplasty incisions are applied to correct upper eyelid dermatochalasis. In this study, we applied and evaluated the shortened infrabrow excision blepharoplasty (sIBEB) combined with the removal of the orbicularis oculi muscle to achieve more satisfactory effects. This retrospective study included 40 women who underwent sIBEB treatment at the Plastic Surgery Hospital of Beijing between February 2019 and June 2021. Preoperative and postoperative photographs, complications, objective Strasser system, and self-assessed subjective evaluations by the patient (on a scale of 1-10) were used to assess the results of the procedure. During the follow-up (6-16 mo; average, 12 mo), all 40 patients (age, 26-68 y; 47±9.44 y) presented effective correction of the dermatochalasis. The objective Strasser evaluation showed that all patients had a score of 0 to 4, and the subjective feedback revealed that 37 patients (92.5%) scored the procedure 9/10, indicating high satisfaction. No complications were detected, and repair surgery was not required in any patient. The application of a shortened incision enables the surgeon to accurately locate the excision area, resulting in less visible scars. Furthermore, removal of the orbicularis oculi muscle allows for the sagittal lifting of the superficial musculoaponeurotic system layer, adjusting the swelling and sagging appearance. The modified sIBEB may achieve more effective, sustainable, and satisfactory outcomes.

Functional brow lifting

Brow ptosis is an abnormal descent of the eyebrow resulting in a displeased appearance and/or functional deficit. While most cases of brow ptosis do not result in a functional impairment, functional brow surgery is generally reserved for individuals with severe brow asymmetry or visual field deficit related to excess soft tissue pushing downwards on the eyelid. A combination of both intrinsic and extrinsic anatomic factors contributes to an unfavorable brow shape, contour, and position. Proper management of brow ptosis requires an understanding of both surgical and non-surgical modalities. Traditionally, individuals with functional brow ptosis are treated by browpexy via blepharoplasty approach, direct browlift, mid-forehead browlift, or less commonly endoscopic browlift.

Mathematical Modeling of Eyebrow Curvature

The aim of the study is to describe a mathematical model for analyzing eyebrow curvature that can be applied broadly to curvilinear facial features. A total of 100 digital images (50 men, 50 women) were obtained from standardized headshots of medical professionals. Images were analyzed in ImageJ by plotting either 8 or 15 points along the inferior-most row of contiguous brow cilia. A best-fit curve was automatically fit to these points in Microsoft Excel. The second derivative of the second-degree polynomial and a fourth-degree polynomial were used to evaluate brow curvature. Both techniques were subsequently compared with each other. A second-degree polynomial and fourth-degree polynomial were fit to all eyebrows. Plotting 15 points yielded greater goodness-of-fit than plotting 8 points along the inferior brow and allowed for more sensitive measurement of curvature across all images. A fourth-degree polynomial function provided a closer fit to the eyebrow than a second-degree polynomial function. This method provides a simple and reliable tool for quantitative analysis of eyebrow curvature from images. Fifteen-point plots and a fourth-degree polynomial curve provide a greater goodness-of-fit. The authors believe the described technique can be applied to other curvilinear facial features and will facilitate the analysis of standardized images.

Putative ratios of facial attractiveness in a deep neural network

Empirical evidence has shown that there is an ideal arrangement of facial features (ideal ratios) that can optimize the attractiveness of a person's face. These putative ratios define facial attractiveness in terms of spatial relations and provide important rules for measuring the attractiveness of a face. In this paper, we show that a deep neural network (DNN) model can learn putative ratios from face images based only on categorical annotation when no annotated facial features for attractiveness are explicitly given. To this end, we conducted three experiments. In Experiment 1, we trained a DNN model to recognize the attractiveness (female/male × high/low attractiveness) of face in the images using four category-specific neurons (CSNs). In Experiment 2, face-like images were generated by reversing the DNN model (e.g., deconvolution). These images depict the intuitive attributes encoded in CSNs of the four categories of facial attractiveness and reveal certain consistencies with reported evidence on the putative ratios. In Experiment 3, simulated psychophysical experiments on face images with varying putative ratios reveal changes in the activity of the CSNs that are remarkably similar to those of human judgements reported in a previous study. These results show that the trained DNN model can learn putative ratios as key features for the representation of facial attractiveness. This finding advances our understanding of facial attractiveness via DNN-based perspective approaches.

Transbrow Excision Blepharoplasty for Upper Eyelid Dermatochalasis: A Modified Approach

BACKGROUNDS

Many aging women with upper lid dermatochalasis pluck their lower lateral eyebrows to combat lateral drooping. The authors present and evaluate outcomes of a modified excision blepharoplasty method performed using a transbrow excision approach instead of infra/suprabrow access to more efficiently correct upper eyelid dermatochalasis.

METHODS

The authors conducted a retrospective review of 192 patients who underwent transbrow excision blepharoplasty (TBEB) between 2014 and 2019 at the Plastic Surgery Hospital of Beijing in China. The clinical features, complications, and outcomes of patients were reviewed. The Strasser grading system was used to evaluate surgical results postoperatively. Aesthetic improvement was subjectively judged by the patients.

RESULTS

All 192 patients (aged 25-72 years old, mean 46 years old) were reviewed and followed up for 6 months to 2 years. Patients were evaluated after 1 week and after at least 6 months. All patients reported an improved aesthetic appearance of the lateral periorbital area, and 174 patients (90.6%) rated their results as satisfactory. No serious complications were related to the procedure.

CONCLUSIONS

TBEB is used to correct problems that are not adequately managed by conventional excision blepharoplasty. Among 192 patients evaluated over 5 years, excision of the transbrow skin pad sufficiently reduced the redundancy of the upper eyelid and achieved an acceptable appearance of the periorbital area, where the postoperative location of a subtle scar defined a desired youthful brow position. In selected patients, this is an effective and safe method that uses patient-observed features to provide an alternate cosmetic approach.

Transposition Upper Blepharoplasty With Orbital Retaining Ligament Release

PURPOSE

Volume restoration is an important component of aesthetic facial rejuvenation, particularly in the brow and upper eyelid regions. In this study, the authors describe transposition of the central, preaponeurotic fat pad in the sub-brow preperiosteal plane with full release of the brow during upper blepharoplasty.

METHODS

A retrospective review including all patients who underwent transposition of the upper eyelid central, preaponeurotic fat pad at the time of upper blepharoplasty. Patients with simultaneous brow lifting surgeries were excluded. The surgical technique involved placement of the preaponeurotic fat pad pedicle in the sub-brow space after full brow release for augmentation of sub-brow volume after performing upper blepharoplasty.

RESULTS

Nineteen patients (n = 36 eyelids) were identified who underwent this transposition upper blepharoplasty technique. No complications or adverse events related to this procedure were observed. All patients were satisfied with their outcome.

CONCLUSIONS

Transposition upper blepharoplasty with complete brow release is a safe, effective adjunct to blepharoplasty for upper eyelid and periorbital rejuvenation.

The Orbital Oval Balance Principle: A Morphometric Clinical Analysis

BACKGROUND

The aim of this study was to test the validity of the "orbital oval balance principle," a system of analysis and guideline that is used among aestheticians, artists, and makeup artists to create and design aesthetically pleasing eyebrows for optimal upper facial appearance. According to this principle, a face is optimally attractive when the eye is centered in an "oval" defined by the lid-cheek junction and the eyebrow.

METHODS

One hundred participants were asked to rank digital morphed images of four female models with four different periorbital proportions: higher or lower lid-cheek junction versus higher or lower eyebrow position. In addition, the participants were asked to quantify seven emotions on these morphed images.

RESULTS

A higher lid-cheek junction was rated as significantly more attractive with a lower eyebrow position, and a lower lid-cheek junction was regarded far more attractive in combination with a higher eyebrow position. Moreover, a higher lid-cheek junction was rated as more attractive than a lower lid-cheek junction, and elevation of the lid-cheek junction improved the perception of emotions such as tiredness and sadness.

CONCLUSIONS

This study lends support to the orbital oval balance principle that can provide important insight into facial attractiveness to surgeons undertaking procedures intended to improve and rejuvenate facial appearance. Moreover, this study has also shown not only that a high(er) lid-cheek junction is regarded as more youthful and attractive, but that it also may reduce the appearance of tiredness and sadness.

Genome-wide association studies and CRISPR/Cas9-mediated gene editing identify regulatory variants influencing eyebrow thickness in humans

Hair plays an important role in primates and is clearly subject to adaptive selection. While humans have lost most facial hair, eyebrows are a notable exception. Eyebrow thickness is heritable and widely believed to be subject to sexual selection. Nevertheless, few genomic studies have explored its genetic basis. Here, we performed a genome-wide scan for eyebrow thickness in 2961 Han Chinese. We identified two new loci of genome-wide significance, at 3q26.33 near SOX2 (rs1345417: P = 6.51×10(-10)) and at 5q13.2 near FOXD1 (rs12651896: P = 1.73×10(-8)). We further replicated our findings in the Uyghurs, a population from China characterized by East Asian-European admixture (N = 721), the CANDELA cohort from five Latin American countries (N = 2301), and the Rotterdam Study cohort of Dutch Europeans (N = 4411). A meta-analysis combining the full GWAS results from the three cohorts of full or partial Asian descent (Han Chinese, Uyghur and Latin Americans, N = 5983) highlighted a third signal of genome-wide significance at 2q12.3 (rs1866188: P = 5.81×10(-11)) near EDAR. We performed fine-mapping and prioritized four variants for further experimental verification. CRISPR/Cas9-mediated gene editing provided evidence that rs1345417 and rs12651896 affect the transcriptional activity of the nearby SOX2 and FOXD1 genes, which are both involved in hair development. Finally, suitable statistical analyses revealed that none of the associated variants showed clear signals of selection in any of the populations tested. Contrary to popular speculation, we found no evidence that eyebrow thickness is subject to strong selective pressure.

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 ± 0.23 and 12° ± 5.2°, 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.

Chen's Double Eyelid Fold Illusion: An Eye Size Assimilation Illusion Induced by a Supratarsal Fold in the Brow-Eye Unit, A Preliminary Report

BACKGROUND

Double eyelidplasty can enhance the eye size and facial attractiveness of Asian individuals with single eyelids. The authors hypothesize that a supratarsal fold can induce an eye size assimilation illusion to enhance eye dimensions and aesthetics, and seek to define the optimum vertical proportion between a supratarsal fold and the eye fissure associated with maximal induction of the size assimilation illusion.

METHODS

A photometric study of the replicated photographs of ten female Taiwanese patients after double eyelidplasty was designed. Each photograph was edited by shifting the supratarsal folds vertically at a regular fold/eye ratio increment of 0.1. The perceived attractiveness of edited photographs of each patient was rated by 100 adult observers using a score of 1-5. The palpebral parameters were measured and analyzed.

RESULTS

The mean rating score increased gradually when a supratarsal fold was added and peaked when the fold/eye ratio was 0.3 and the mean Chen's double eyelid fold ratio was 0.631 ± 0.023. After the peak, the mean score decreased gradually and was lower than the photograph without a fold when the fold/eye ratio exceeded 0.5 and the mean Chen's ratio exceeded 0.729 ± 0.027.

CONCLUSION

Within the optimal ranges of the fold/eye ratio and Chen's double eyelid fold ratio, eyes are perceived as larger and more attractive due to a hybrid presentation of two interdependent eye size assimilation illusions induced by a supratarsal fold in the brow-eye unit. "Chen's double eyelid fold illusion" is proposed to describe this complex visual phenomenon.

LEVEL OF EVIDENCE IV

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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transcutaneous Brow Shaping: A Straightforward and Precise Method to Lift and Shape the Eyebrows

BACKGROUND

The height of the eyebrow is less crucial aesthetically than is the relationship between the lateral and medial portions of the brow. Although various surgical procedures are effective in raising the brow, the authors maintain that transcutaneous brow shaping (TBS) is the only technique that enables precise shaping of the brow and correction of minor asymmetries.

OBJECTIVES

The authors described their experiences with direct TBS alone or in conjunction with blepharoplasty and facelift.

METHODS

A total of 212 patients underwent TBS performed by the senior author (M.P.C). All patients were evaluated clinically and by means of pre- and postoperative photographs. Patients completed questionnaires indicating scar quality and satisfaction with the results.

RESULTS

There were no major complications. Scar visibility was low, and patients expressed a high level of satisfaction with the aesthetic results of TBS.

CONCLUSIONS

A misconception of transcutaneous browlift procedures is that they yield visible scars. TBS requires accurate planning, preservation of subcutaneous volume, limited undermining, preoperative application of botulinum toxin, and perioperative administration of local vasodilators. When these requirements are fulfilled, the authors have found that TBS does not yield a visible scar and is the easiest, most precise, and most reliable procedure for brow shaping.

LEVEL OF EVIDENCE

4.

Determinative factors in surgical planning of eyebrow cosmetic and reconstructive surgery

PURPOSE

The purpose of this study was to identify the different factors that an oculoplastic surgeon should consider while practicing cosmetic or reconstructive eyebrow surgery in order to have the final patient's satisfaction.

SUBJECTS AND METHODS

In an observational case series study, five photographs were taken from each of 60 females to show ideal eyebrow positioning with fingers. Eyebrow landmarks, including tarsal plate show (TPS) and eyebrow height, were measured in the ideal position. Brow apex position and brow apex angle were evaluated in the desired position of eyebrow.

RESULTS

The mean desired apex angle of eyebrow was measured as 135±9 mm. In all, 48.33% of our subjects preferred a wider brow angle, 28.33% a narrower one, and 23.33% a brow angle without any change. The location of brow peak was transferred to the lateral canthus in the desired position. The ideal brow peak in the lateral canthus and between lateral canthus and lateral limbus was assigned to 33.3% and 66.6% of cases, respectively. The desired eyebrow apex angle in two age groups of our subjects (>40 years and ≤40 years) was not statistically different.

CONCLUSION

Landmarks of the eyebrow and its desired position are somehow different between different studies, which may be explained by the variation in race, gender, culture, and age. As there is not any uniform rule in planning of cosmetic surgeries of eyebrow, oculoplastic surgeons should consider the difference in culture, race, age, and desire of the patients and have their surgical plans for every individual patient distinctively.

Volumization of the Brow at the Time of Blepharoplasty: Treating the Eyebrow Fat Pad as an Independent Unit

PURPOSE

Loss of volume in the sub-brow fat pad with associated descent of the eyebrow is a common anatomical finding resulting in both functional and aesthetic consequences. A variety of techniques have been described to address brow position at the time of blepharoplasty. To our knowledge, none of these techniques treat the sub-brow fat pad as an isolated unit. Doing so enables the surgeon to stabilize and volumize the brow without resultant tension on the blepharoplasty wound. The authors describe a technique for addressing volume loss in the eyebrow with associated brow descent that treats the sub-brow fat pad as an isolated unit.

METHODS

A retrospective review of all patients undergoing brow ptosis repair by a single surgeon (J.W.S.) over an 11-month period was performed.

RESULTS

Eighteen patients and 33 brows underwent the technique described. Patients were followed for an average of 11 weeks (range: 4 weeks to 20 weeks). All patients preoperatively displayed both visually significant dermatochalasis and brow descent below the orbital rim. Evaluation of pre- and postoperative photos demonstrates successful volumization of the brow with skin redraping without focal dimpling or undue tension on the eyelid wound.

CONCLUSIONS

Performing a dissection that allows the sub-brow fat pad to be elevated in isolation from the overlying orbicularis and underlying periosteum allows for volumization and of the brow without compromising closure. This technique is a safe and effective means of volumizing the brow and treating secondary brow descent.

Ideal or Young-Looking Brow Height and Arch Shape Preferred by Koreans

The aim of this study is to see which brow height and arch shape is preferred as ideal or young-looking by Koreans. A survey was conducted between June and Dec 2014 on 186 women who visited the brow bar ("Benefit" of Incheon city). They were asked to choose which they believed ideal and youngest amongst the 3 brow archetypes according to their height and 4 types of modification of Anastasia (rotation of medial and lateral arms), which was illustrated. Approximately half (52.5%) of the respondents answered that their brow matches them very well or well. Most (81.2%) believed there might be a method to yield an ideal brow archetype and almost all (97.3%) would change the brow shape if the expert advised. The most preferred ideal brow height was of a middle height (63.2%, the distance from the lateral canthus to the lateral end of eyebrow, which was 2/3 of the eye width). The most preferred ideal brow arch shape was the arched type (57.6% arches on a line drawn from the center of the nose through the center of the pupil). The most preferred young-looking brow height was of an upper height (46.2%, the distance from the lateral canthus to the lateral end of eyebrow was 3/4 of the eye width) followed by a middle height (39.7%). The most preferred young-looking brow arch shape was the head-up position (53.3%, medial arm of the brow was rotated upward to the horizontal plane). The result of this study might be useful in facial rejuvenation surgeries as well as in brow esthetics or tattooing of the eyebrows.

Brow/Upper lid anatomy, aging and aesthetic analysis

The upper eyelid serves the important anatomic function of protecting the eye and rewetting the cornea to maintain vision. The complex dynamic action of the upper eyelid explains its relatively complex anatomy. The brow has an important supportive role. Studies have revealed facial characteristics perceived as youthful and aged, and the anatomic basis of these changes is defined at many levels. Characteristic aging changes in the upper eyelid and brow create an appearance of aging and opportunities for functional and aesthetic improvement.

Subcutaneous lateral brow lift ("Z-lift")

Surgical eyebrow lift has been described by using many different open and endoscopic methods. Difficult techniques and only short time benefits oft lead to patients’ complaints. We present a safe and simple temporal Z-incision technique for eyebrow lift in 37 patients. Besides simplicity and safety, our technique shows long lasting aesthetic results with hidden scars and a high rate of patient satisfaction.

Brow archetype preferred by Korean women

The aim of this study is to see which brow archetype is preferred by Korean women. The archetypes were chosen from a literature search, which contain detailed, replicable methods and have diagrams (Westmore, Lamas, Anastasia, Schreiber, and Hwang). A survey was conducted on 300 subjects (group A, 100 female medical students; group B, 100 women who had visited a plastic surgery clinic for periorbital rejuvenation; and group C, 100 women who visited the brow bar). They were asked whether they think there might be a method that yields an ideal brow archetype. In the cases where they said yes, they were asked to choose 1 of the illustrated 5 brow archetypes that they think is ideal. Among the 300 respondents, 232 (77.3%) thought there might be a method to yield an ideal brow archetype, whereas 68 (22.7%) answered they did not. The preference for the brow archetypes was different among the 5 archetypes (P = 0.0001, χ2). Anastasia was the most preferred (44.8%, brow starts on a perpendicular line drawn from the middle of the nostril, arches on a line drawn from the center of the nose through the center of the pupil, and ends on a line drawn from the edge of the corresponding nasal ala through the outer edge of the eye). Anastasia was followed by Lamas (22.0%). In group A, Anastasia (55.7%) was the most preferred, followed by Lamas (26.2%) and Westmore (13.1%). In group B, Anastasia (34.8%) was the most preferred, followed by Lamas (30.3%) and Westmore and Schreiber (both 13.5%). In group C, Anastasia (47.6%) was the most preferred, followed by Hwang (25.5%) and Westmore (11.0%). There was a significant difference (P < 0.001) among the 3 groups. There was a significant correlation between the preference of brow archetype and occupation (P = 0.0033). However, no significant differences were noted for the preference of brow archetype between the age groups of younger than 30 years and older than 30 years (P = 0.1374), level of education (P = 0.3403), marital status (P = 0.541), or monthly income (P = 0.1696, χ2). The result of this study might be useful in facial rejuvenation surgeries as well as in brow esthetics or tattooing of eyebrows.

Eye shape illusions induced by eyebrow positions

We investigated whether the position of the eyebrows influences the perceived shape of the eyes by employing psychophysical measurements. Experiment 1 used arched and straight eyebrows at five different inclinations as stimuli and measured the perceived inclination of the eyes. The results demonstrated that the eyes are perceived to be somewhat inclined in the same direction as the eyebrows. Experiment 2 measured the perceived eye size by manipulating the distance between the eyes and the eyebrows and the curvature of the eyebrows across three levels. The results showed that the lower eyebrows (ie closer to eyes) made the eyes appear larger and the higher eyebrows made the eyes appear smaller, while eyebrow curvature had no effect on perceived eye size. Experiment 3 examined the role of the eye-eyebrow distance in the eye inclination illusion shown in experiment 1. The eye inclination illusion was unaffected by the eye-eyebrow distance, suggesting that the eye inclination illusion and the eye size illusion may involve different kinds of assimilation. These illusions are discussed in terms of face perception and possible practical applications.

Comparison among three different fixation techniques in temporal brow lift surgery

INTRODUCTION

The eyebrow lifting with temporal approach is an increasing widespread technique. Many surgical procedures are described, but the long-term stability is dependent on the effectiveness in the fixation of elevated tissues. The authors compared 3 different fixation techniques in temporal brow lift.

METHODS

Forty-five consecutive patients aged between 33 and 70 underwent brow lift surgery with temporal approach. Patients were divided into 3 groups; in group 1, anchorage was performed with Endotine Ribbon, group 2 with a Mersilene mesh, and group 3 with a Prolene suture. The amount of brow elevation was assessed comparing the distance between interpupillar line and superior eyebrow hairline, measured at the midpupil and at the lateral and medial canthal angle. The follow-up was 1 year.

RESULTS

All patients had a pleasant improvement in brow shape. The average initial brow position was 19.84 mm near the head of the eyebrow area, 20.74 mm at the body, and 19.57 mm in the region of the tail. A progressive recovery and a partial relapse regarding the eyebrow body (23.88 mm at 6 months and 23.02 mm at 1 year) occurred, but overall for the lateral region, it passed from 27.53 mm at 6 months to 25.80 mm after a 12-month follow-up. Final brow position was dependent upon surgical technique used in fixation.

DISCUSSION

Different options in brow elevation and stabilization affect the final shape and position of the brows. From the statistical analysis, mesh suspension provided the best results in terms of long-lasting stability.

LEVEL OF EVIDENCE

Therapeutic III.

A real-life illusion of assimilation in the human face: eye size illusion caused by eyebrows and eye shadow

Does an assimilative illusion like the Delboeuf illusion occur in the human face? We investigated factors that might influence the perceived size of the eyes in a realistic face. Experiment 1 manipulated the position of the eyebrows (high or low), the presence/absence of eye shadow, and the viewing distance (0.6 m or 5 m), then measured the perceived eye size using a psychophysical method. The results showed that low eyebrows (i.e., closer to the eyes) make the eyes appear larger, suggesting that the assimilation of eyes into the eyebrows is stronger when the eye-eyebrow distance is shorter. The results also demonstrated that the application of eye shadow also makes the eyes look larger. Moreover, the effect of eye shadow is more pronounced when viewed from a distance. In order to investigate the mechanism of the eye size illusion demonstrated in Experiment 1, Experiment 2 measured the magnitude of the Delboeuf illusion at a viewing distance of 0.6 m or 5 m, with or without gray gradation simulating the eye shadow that was used in Experiment 1. The experiment demonstrated that the Delboeuf illusion is modulated by viewing distance and gradation in the same way as the eye size illusion. These results suggest that the eye size illusion induced by the eyebrows and the Delboeuf illusion involve the same mechanism, and that eye shadow causes the assimilation of the eyes into itself and enhances assimilation between the eyes and the eyebrows.

The lateral brow: position in relation to age, gender, and ethnicity

PURPOSE

Despite multiple studies regarding modes of eyebrow measurement and movement over time, the lateral aspect of the brow has been relatively ignored in the literature. Therefore, we arranged a study of the most lateral aspect of the eyebrow; in doing so, we hoped to ascertain the most practical line or angle of measurement.

METHODS

In this cross-sectional study, adults age 18 years and older with no history of congenital or acquired periorbital or orbital pathology or surgery, brow tattooing or heavy plucking, phthisis, or strabismus were measured using a combination of in-office metrics and computer analysis. Subjects were asked to identify their ethnicity and country of origin. Models of age, gender, and ethnicity were created.

RESULTS

One thousand twenty-four subjects were included (1,944 eyes). Measurements of nasal ala to lateral brow (NALB), lateral brow plumb line (LBPL; the vertical line between the tail of the brow and a horizontal line extending from the lateral canthus), and angle from the midbrow to the lateral brow tail showed statistically significant decline over time. The angle and LBPL varied mostly by ethnicity. The angle narrowed approximately 3° per 20 years, while the LBPL fell approximately 2.5 mm per 20 years. The NALB varied most by age and fell approximately 3 mm per 20 years.

CONCLUSIONS

The lateral tail of the brow descends with age. Measurements of its location and rate of change vary between genders and within ethnic groups. Two easily measured values-NALB and LBPL-can be used for preoperative planning and postoperative documentation.

Contemporary concepts in brow and eyelid aging

This article outlines current concepts in aging brows and lids, and focuses on the current "evolution" to the 3-dimensional construct. Relevant anatomy is reviewed in detail because thoughtful analysis of the underlying anatomy, ethnicity, gender, and goals of each patient will greatly enhance our ability to address site-specific corrections to achieve optimal and natural-looking results.

Life history of female preferences for male faces: a comparison of pubescent girls, nonpregnant and pregnant young women, and middle-aged women

Although scientific interest in facial attractiveness has developed substantially in recent years, few studies have contributed to our understanding of the ontogeny of facial preferences. In this study, attractiveness of 30 male faces was evaluated by four female groups: girls at puberty, nonpregnant and pregnant young women, and middle-aged women. The main findings are as follows: (1) Preference for sexy-looking faces was strongest in young, nonpregnant women. (2) Biologically more mature girls displayed more adultlike preferences. (3) The intragroup consistency for postmenopausal women was relatively low. (4) In terms of the preference pattern, pregnant women were more similar to perimenopausal women than they were to their nonpregnant peers. (5) Preference for youthful appearance decreased with the age of the women. I argue that the life history of female preferences for male faces is, to a large extent, hormone-driven and underpinned by a set of evolutionary adaptations.

The blue-eyes stereotype: do eye color, pupil diameter, and scleral color affect attractiveness?

BACKGROUND

Blue eyes have been the embodiment of attractiveness not only for decades but even for centuries. The primary aim of this study was to determine whether iridal color, particularly color blue, can increase the attractiveness of a person's eye area. As a secondary aim, the study examined the impact of pupil diameter and scleral color on the attractiveness of the eye area.

METHODS

The stimulus material comprised images of the eye areas of 60 women ages 15-65 years. A total of 80 participants rated the attractiveness of each eye area on a 7-point Likert scale and estimated the age of the person. The color values of the iris and sclera were measured. As an additional subsample, 50% of the participants were asked what features of each eye area they found particularly appealing.

RESULTS

Most surprisingly, no correlation was found between iridal color and rated attractiveness. However, the participants mentioned the color blue more often as a positive aspect than other iridal colors. A high inverse correlation was observed between attractiveness of the eye area and age. The larger the pupil diameter and the whiter the scleral color, the lower was the real and perceived age and the higher was the attractiveness.

CONCLUSION

The data showed that the "blue-eyes stereotype" does exist. People consider blue eyes attractive, but in reality, blue is rated as attractive as other iridal colors. Bright scleral color and large pupils positively affect attractiveness because both features are significantly correlated with youthfulness.

Measurement of eyebrow position from inferior corneal limbus to brow: a new technique

PURPOSE

To develop a standard measure of eyebrow position for evaluation of eyebrow ptosis and to provide normative measurements for eyebrow position using this easily reproducible measure.

METHODS

A noncomparative interventional case series was performed. Measurements of eyebrow position were made on 213 subjects without cosmetic or functional complaints who presented to the eye clinic for routine eye examination during a 1-year period. Measurements were taken in the primary position of gaze. Central eyebrow height was measured as the distance from the central inferior corneal limbus to the first row of mature brow hairs (ILB) under loupe magnification. Additional measurements included the distance from the upper eyelid margin to brow, margin reflex distance-1, and palpebral fissure width.

RESULTS

Of the 213 subjects, 56 (26.5%) were male and 157 (73.5%) were female. Ages ranged from 5 to 80 years. Mean ILB height was 19.4 mm for males and 19.7 mm for females. The ILB was not associated with measures of eyelid height such as palpebral fissure width. There was no statistically significant difference in ILB height between males and females. However, increased ILB height was associated with increased age. African Americans had statistically significant increased mean ILB measurements compared with whites.

CONCLUSIONS

Measurement of ILB height provides an accurate and easily reproducible measure of eyebrow height that may be useful in the diagnosis and treatment of conditions affecting the middle and upper face. Race, but not sex, seems to be an important consideration in proper central eyebrow position.

Investigation of anthropometric measurements of anatomic structures of orbital soft tissue in 102 young han chinese adults

PURPOSE

The aim is to measure and investigate the anatomic structures of orbital soft tissue and the relationships between the adjacent regions in 102 normal young Han Chinese adults using a computer-assisted photography system to provide reference data for periocular cosmetic and reconstructive surgery.

METHODS

A random sample of 102 Han young Chinese adults (53 males and 49 females) aged from 18 to 25 years in Changsha, Hunan Province, was obtained. Standard digital images were taken and then processed using Image-Pro Plus 6.0 software. The linear and angular measurements, including intercanthal distance, outer canthal distance, palpebral fissure width (PFW), palpebral fissure height (PFH), orbit height (OH), upper lid height, lower lid height, nasal eyebrow height, central eyebrow height, temporal eyebrow height, reference line to lateral canthus'inclination of palpebral fissure, were measured. The proportional indices, including intercanthal distance/outer canthal distance, PFH/PFW, PFH/OH, OH/PFW, upper lid height/OH, lower lid height/OH, nasal eyebrow height/OH, central eyebrow height/OH, and temporal eyebrow height/OH, were investigated.

RESULTS

Means and standard deviations of all the items had been obtained and differences between male and female subjects were assessed.

CONCLUSIONS

The normal measurement values of anatomic structures of orbital soft tissue and the proportional indices for normal young Han Chinese adults provided reference data for periorbital cosmetic and reconstructive surgery.

Eyebrow peak position redefined

BACKGROUND

The aesthetically appealing eyebrow shape has been defined by its arch, located near the junction between the medial two-thirds and lateral one-third. The position of this arch has been historically described by arbitrary anatomical landmarks that have no logical structural relationship. Moreover, selection of endoscopic brow lift incision sites that define vector of pull and fixation points have been variably described.

OBJECTIVES

The authors examine the position of the deep temporal fusion line to determine whether it can act as a more accurate and functional landmark than prior anatomical landmarks for the eyebrow peak position.

METHODS

Eyebrows were measured in 50 subjects from the medial aspect of the eyebrow to the a) deep temporal fusion line (ridge), b) eyebrow peak (arch), c) lateral aspect of the brow, and d) lateral limbus. Pearson's correlation, descriptive statistics, and student's t test results were obtained.

RESULTS

Eyebrow measurements demonstrated that the deep temporal fusion line is the most precise indicator of brow peak position among all examined landmarks. The Pearson correlation value was strongest between brow peak and deep temporal fusion line (P = .860) and a t test confirmed this observation with no significant difference between brow peak and deep temporal fusion line. The lateral limbus and medial two-thirds lateral one-third junction more accurately predict brow peak in females, but the deep temporal fusion line is an equally reliable predictor of brow peak for males and females.

CONCLUSIONS

These findings suggest that placement of endoscopic brow lift incisions and subsequent fixation points may be best defined along the deep temporal fusion line.

Approach to eyebrow ptosis through the modified technique of Castanares

One of the first signs of facial ageing appears in the forehead, with the descent of the lateral part of the brow. This is a troubling condition for all patients and elevation of the lateral part of the brow becomes a more and more frequent demand. The authors present their experience in 350 consecutive cases of direct eyebrow lift ("butterfly wing" incision) alone or in combination with rhytidectomy and/or blepharoplasty. The majority of the patients were female (90%). The age ranged from 43 to 85 years. Eighty per cent of the cases were performed simultaneously with rhytidectomy and blepharoplasty, 16% were performed in association with blepharoplasty and eyebrow lift alone represented 4%. The most common complication was epidermal cyst (3.4%) and suture dehiscence (2%). The "butterfly wing" incision provides a useful alternative to correction of eyebrow ptosis. Indication for surgery is dependent more on the ageing signs than on the patient's chronological age. The final results are consistently very gratifying to the patient and to the plastic surgeon alike.

The "jaguar's eye" as a new beauty trend? Age-related effects in judging the attractiveness of the oblique eye axis

BACKGROUND

The eye area plays an important role in the assessment of a person. Although plastic surgery in this area is quite common, only a few studies have evaluated the features that create an attractive eye. This study aimed to determine whether a preference exists for a certain eye axis.

METHODS

The stimulus material comprised portrait images of seven women. Two versions of each face were generated that differed only in the position of the eye axis (normal vs rotated). The eye axis was rotated by raising the lateral canthus of the eye about 5 degrees . A total of 250 experimental subjects ranging in age from 15 to 84 years stated their preferential position of the eye axis (horizontal vs oblique).

RESULTS

Clear evidence showed that age has an impact on the type of eye axis preferred. Young subjects (age, B 19 years) regarded the oblique type of eye axis as more attractive, whereas older subjects (age, C50 years) preferred the eyes more horizontal (p \ 0.001), independently of the interviewees' gender.

CONCLUSION

Because young people judge eye attractiveness differently than older people and because beauty trends are normally determined by young people, a future ideal of beauty could be characterized by eyes with a gently oblique eye axis.