Does the Eyebrow Sag with Aging? An Anthropometric Study of 95 Caucasians from 20 to 79 Years of Age (2016)

Sir: We read with great interest the article “Does the Eyebrow Sag with Aging? An Anthropometric Study of 95 Caucasians from 20 to 79 Years of Age” by Bruneau et al.,1 and applaud their valuable addition to the literature on the subject of eyebrow position and aging. As the authors note, the eyebrow has long been considered a pivotal structure in facial aesthetics. Numerous studies have attempted to establish ideal criteria for eyebrow position and characterize changes of the eyebrow during the facial aging process.2 However, results have been disparate and a consensus on normal eyebrow position and how it relates to facial aging has yet to be reached. In an effort for further clarification, the authors provided a thought-provoking study aimed at evaluating eyebrow position in various age groups. Despite the study’s compelling results that eyebrow position is stable during aging, we have identified several issues that warrant further discussion. In the current study eyebrow height was evaluated by measuring the vertical distance between the upper eyebrow margin and a horizontal reference line (intercanthal line) at four points: medial canthus, iris center, lateral sclerocorneal limbus, and lateral canthus.1 No significant differences were found when comparing eyebrow height at any of these points between the three age groups (20 to 39, 40 to 59, and 60 to 79 years of age). Although we agree that medial and central eyebrow height may remain stable, it is less clear that the relative height of the lateral brow does. We have previously demonstrated that lateral canthal complex descent is a significant component of periorbital aging.3 Therefore, one would assume that as the lateral canthal complex descends during aging, the relative height of the lateral brow would increase. We would ask that the authors provide an explanation as to the discrepancy of these findings. An additional issue lies in the fact that only Caucasians were included. Ethnic considerations have become increasingly important in aesthetic plastic surgery. Price et al. found that race, gender, and age differences exist for eyebrow position.4 Specifically, African American eyebrow height was increased relative to Caucasian eyebrow height regardless of age, and older African American men had significantly increased eyebrow height relative to younger African American men. Although we understand that the demographic makeup of the local population dictates whether certain populations of patients can be studied, it would be interesting if Bruneau et al. found that their results were applicable to non-Caucasian individuals as well. Indeed, it is incumbent on all of us to further characterize the extent to which ethnic differences affect eyebrow position and facial aging. Another important consideration is static versus dynamic assessment. The authors do not address compensatory position of the brow, something that is critical in ophthalmic plastic surgery. Experience with botulinum toxin has shown that perceptions of brow positioning can be dramatically altered cephalad or caudad.5 We therefore suggest that a true change in brow positioning is likely present but compensated by resting frontalis tone, and immobilization of this tone would have yielded different study results. Finally, we thank the Journal for bringing this important topic to light and feel its great value can be enhanced by the caveats reviewed above. DISCLOSURE The authors have no financial relationships to disclose with respect to this communication. Chad M. Teven, M.D.Julius W. Few, M.D.Section of Plastic and Reconstructive SurgeryUniversity of Chicago MedicineChicago, Ill.