Eyebrow Reconstruction: Options for Reconstruction of Cutaneous Defects of the Eyebrow

Morphometric characteristics of feminine eyebrows: variations with ethnicities and age

OBJECTIVE

To explore some morphological features of the eyebrows of women of different ethnicities and ages.

MATERIALS AND METHODS

Standard digital photographs of 3600 women of six ethnicities, aged 18-84 years, previously used to describe the morphology of the human eyes, allowed us to focus on their eyebrows, as supplementary and opportunistic study. Photographs of both eyebrows were analysed partly by manual markings and automatically by dedicated algorithms. Six parameters of the eyebrows were recorded: length, waviness/curvature, oblique aspect, size (vertical height), total surface and hair coverage (density).

RESULTS

Most criteria present ethnic specificities. These are: length (longer eyebrows of Indian, shorter among African women); waviness where the straighter eyebrows were found among Chinese and Japanese women. In general, the longer the eyebrows, the higher their waviness and vice versa. Thickness (or height) of the eyebrows presents a wide ethnic variability as well as hair coverage, where African women present the lower hair density, inversely to Indian women. The same holds true with regard to the total surface of eyebrows, of a large variability (by about four times). Some criteria appear more individually dependent than ethnic-specific, such as the oblique positioning, at the exception of Indian women with less oblique eyebrows. In all subjects, the criteria of both eyebrows (Left vs. Right) were found to be highly correlated (r > 0.7, P < 0.001).

CONCLUSION

The present investigation brings new findings on a scarcely studied facial element, the morphologic features of which are, for most, ethnic-dependent. As applied consequences, the results of the present work pave the road to better adapt adorning procedures of the eyebrows vis-à-vis ethnic and age specificities.

Eyebrow reconstruction using a composite skin graft from sideburns

Supplemental Digital Content is available in the text.

Wide resection of malignant skin tumors in the upper orbital region often results in soft-tissue defects involving the eyebrow. We used composite skin grafts from the area around the sideburns for 1-stage reconstruction of skin and eyebrow defects. The results were aesthetically satisfying because the hair and shape of these regions were similar to those of the original eyebrow, and donor-site closure was easy with inconspicuous scar. The survival of full-thickness skin graft area of composite grafts from sideburn facilitates revascularization of thicker hair follicles in the graft and allows safe, natural eyebrow reconstruction.

Freestyle-like V-Y flaps of the eyebrow: a new outlook and indication of an historical technique

The eyebrow region is of utmost importance for facial movement, symmetry, and the overall cosmetic appearance of the face. Trauma or tumor resection often leave scars that may dislocate the eyebrow producing an alteration both in static symmetry of the face and in the dynamic expressivity. The authors present a technique for eyebrow's defects repair using the remaining eyebrow advancement by means of a "freestyle-like" V-Y flap. In the past two years a total of eight consecutive patients underwent excision of skin lesions in the superciliary region and immediate reconstruction with this technique. On histology, six patients were affected from basal cell carcinomas, one from squamous cell carcinoma, and one from congenital intradermal melanocytic nevus. The pedicle of the flap included perforators from the supratrochlear, supraorbital, or superficial temporalis artery. Advancement of the entire aesthetic subunit that includes the eyebrow using a V-Y perforator flap was performed successfully in all cases achieving full, tension-free closure of defects up to 3.0 cm. "Freestyle-like" V-Y flaps should be considered as a first-line choice for partial defects of the eyebrow. The greater mobility compared to random subcutaneous flaps allows to reconstruct large defects providing an excellent cosmetic result.

[Eyebrow reconstruction]

The eyebrow is an essential anatomical area, from a social point of view, so its reconstruction, in case of skin defect, must be as meticulous as possible, with the less residual sequela. Capillary density extremely varies from one person to another and the different methods of restoration of this area should absolutely take this into consideration. We are going to review the various techniques of reconstruction, according to the sex and the surface to cover.

Reshaping the eyebrow by follicular unit transplantation from excised eyebrow in extended infrabrow excision blepharoplasty

PURPOSE

We report the reshaping of the eyebrow by follicular unit transplantation from excised eyebrow skin in extended infrabrow excision blepharoplasty.

METHODS

The method was carried out in two patients with moderate or significant dermatochalasis. The areas to be excised from the infrabrow and intrabrow skin were decided upon and the area of hair transplantation was planned in the suprabrow area and the tail of the eyebrow. The skin was removed and the excised intrabrow skin was dissected into single follicular units. Tiny incisions were made with a scalpel, and grafts were inserted using fine forceps.

RESULTS

Almost all transplanted eyebrow follicles took successfully, resulting in eyebrows of a desirable shape as planned preoperatively. The reshaped eyebrows had a natural appearance since the transplanted hairs were similar to those of the original eyebrow. The eyelids still looked youthful rather than operated-on. Finally, the evidence of blepharoplasty was hardly visible and patient satisfaction was quite high. The patients felt more ease in opening their eyes and obtained a wider visual field.

CONCLUSION

Our study demonstrated excellent results with hair transplantation from eyebrow to eyebrow, a finding which, to our knowledge, has not been previously reported. Our method can be used for selected patients, especially men, with moderate to severe dermatochalasis, who find a reduction or change in the shape of the eyebrow unacceptable.