The aesthetics of the eyebrows

This entry addresses the aesthetics of the eyebrows in women; note the emphasis on a feminine appearance.  The ideal shape that the author talks about in the introduction is applicable to white women and oval faces.

Aesthetic Considerations in the Elevation of the Eyebrow

James C. Alex
M.D., F.A.C.S.
Facial Plast Surg 2004; 20: 193-198
DOI: 10.1055/s-2004-861774

ABSTRACT

In an increasingly diverse and multicultural society, it becomes increasing imperative to understand the aesthetics and proper analysis of the face, particularly as it applies to forehead lifting and elevation of the eyebrow. Most articles published to date have emphasized the surgical anatomy and/or surgical technique of forehead lifting and addressed the question of brow aesthetics in a uniform, generalized fashion. In addition, the emphasis on brow elevation as a means to brow/upper lid rejuvenation can further distract the surgeon from appreciating each person's unique brow aesthetics. This article examines current surgical concepts of brow/upper lid proportion and harmony and compares and contrasts them with cultural notions of the “pleasing brow” as represented by the makeup and fashion industries. There is great variation in what is considered to be a “beautiful brow,” and the facial plastic surgeon must understand the nuanced elements of eyebrow configuration that contribute to the overall balance and harmony of the face.

KEYWORDS: Brow position, periorbital, endoscopic, brow lifting.

SURGICAL NORMS IN BROW POSITION

A review of several textbooks and articles that discuss brow position reveals a consistent consensus as to the proper qualitative relationships of the ideal eyebrow position[1][2][3]; these include (Fig. [1]):

• The medial extremity of the eyebrow lies in a vertical plane passing through the alar base.
• The lateral eyebrow ends at an oblique line drawn from the alar base through the lateral canthus.
• The medial and lateral ends of the eyebrow lie at the same horizontal level.
• The apex of the eyebrow lies vertically above the lateral limbus of the eye at approximately the junction of the medial two thirds and the lateral third of the eyebrow.
• The eyebrow arches above the supraorbital rim in women and lies at the rim in men.
• The male eyebrow tends to be heavier and less arched than the female brow.

Some authors differ from this norm, stating that as the female brow rises laterally, it should peak at the lateral canthus and not at the lateral limbus (Fig. [1B]).[4] It should be noted, however, that the preceding criteria of the idealized brow are based on an idealized concept of facial shape-the oval-and do not account for different facial types among individuals.

Figure 1 (A) The “ideal” brow position. The high point of the brow is at the lateral limbus of the eye. (B) An attractive and balanced brow with the high point of the brow at the lateral canthus of the eye.

Another approach has been to quantify the proper eyebrow position.[5][6] McKinney et al[5] measured the brow height in 50 women 14 to 32 years of age. The average distance from the top of the brow to the midpupil was 2.5 cm (range of 2.3-2.9 cm); and from the top of the brow to the anterior hairline was 4.8 cm (range of 4.0-6.2 cm). Other measurements such as medial canthus to top of brow, lateral canthus to top of brow, and lid margin to top of brow have also been “determined.”[6][7] The difficulty with these studies is that these generalized “normative” measurement values do not instruct the surgeon as to what are the best values to uniquely enhance a particular individual's attractiveness. Also, by ignoring the aesthetic relationship between brow shape and position and the face, all facial forms are unconsciously reduced into one type. The emphasis on individualized facial analysis with a goal to balance and harmonize each person's distinctive facial characteristics is lost.

In reality, the ideal shape, length, and position of the brow must be appropriately altered to fit different shapes of faces. For instance, in round faces the brow is kept shorter and placed higher, as a longer lateral third would produce a moon-shaped face.[8]

The observant facial plastic surgeon need only look at the work of makeup artists to realize that the beautiful eyebrows they create can vary greatly from these “norms.” When surgically creating the ideal eyebrow position, the surgeon should look beyond the generalized numbers and relationships to the individual characteristics of the brow and the facial shape that truly determine the most aesthetic brow appearance for a given person.

MAKEUP ARTISTS AND CHARACTERISTICS OF THE FACE AND IDEAL BROW

The use of makeup has been a part of every civilization beginning with the Egyptians and Greeks.[9] Proper shaping of the eyebrow enhances not only the intrinsic beauty and power of the brow but also that of the eyes and face. As world-famous makeup artist Kevyn Aucoin wrote,[10] “To me, the eyebrows are the most important feature of the face. They're the most expressive feature, as well as the one that can be changed most drastically…”

With makeup, aesthetic changes are made to the brow to balance and harmonize the face. The facial plastic surgeon can produce similar nuanced cosmetic changes with surgery. Discrete elevation of the medial, central, and/or lateral portions of the brow can be achieved with the variety of advanced brow and forehead lifting techniques. Thus, it is critical when balancing the face to know not only whether the brow should be elevated but also which parts of the brow elevated and why.

One of the major differences between the idealized brow of surgical texts and that of makeup artists is that the former is based on the ideal face-the oval-whereas the latter is individually matched to a person's unique facial shape. For instance, Stephanie Seymor, Jennifer Love Hewitt, and Claudia Schiffer all have long faces and their eyebrow shape is flat and position relatively low. This shape makes the face appear more oval, drawing the eye from side to side rather than up and down the face.

As is seen with clothing and art, horizontal lines make long objects appear more round and vertical lines create the illusion of length in round objects.

In attempting to “ovalize” the face, a basic progression is followed[8]: (1) using the eye color and complexion, determine the individual's natural color; (2) determine the individual's facial shape; (3) ovalize the face with shading (dark colors deepen an area and light colors bring it forward); and (4) treat individual features-eyes, lips, and eyebrows-to effect. The eyebrows are a critical component both intrinsically and in helping to ovalize the face.

There are five basic brow shapes (Fig. [2]): (1) curved, (2) sharp angled, (3) soft angled, (4) rounded, and (5) flat. For those brow shapes with an arch, further differentiation into low, medium, and high arch can be made. These eight primary brow characteristics can be manipulated to create the best balance for a given face shape.

Figure 2 The five basic eyebrow shapes.

The round brow shape softens and adds a gentle roundness to the face, toning down sharp, angulated features such as a pointed chin. The high, sharp peak of the sharp angulated brow adds energy and youth to the face. It can function to slim a round or diamond-shaped face, and it can complement and balance other strong facial features such as a square jaw or prominent cheek bones. The soft angled brow creates a similar effect while maintaining a softer, more feminine appearance. The curved brow projects a feeling of energy, confidence, and professionalism and works particularly well on a square or oval face. As mentioned earlier, the flat brow is perfect for individuals with a long face, creating a shorter, more ovalized look.

The importance of the brow in facial balancing is underscored by Nancy Parker, who notes, “the improper selection of brow shape can be disastrous. For example an angulated, highly arched brow can help make a round face appear more oval, but a round brow can turn that same face into a beach ball.”

Following are common recommendations for brow shape and position based on facial shape.[8][10]

The Oval Face Shape

• This is the ideal facial shape. It is intrinsically balanced. The brow plays no significant role in making the face appear “more oval.”
• Selection can be guided by personal taste.
• Grace Kelly, Ashley Judd, Jewel.

The Round Face Shape

• To make a round face appear oval, one should apply lines that go up the face. This draws the eye more up and down and stops it from going side to side.
• A high arched brow accomplishes this.
• The peak is best moved out toward the end of the brow. This lets the lines of the brow go up and down as much as possible. The tail should therefore be short.
• Uma Thurman, Cameron Diaz, Vanessa Williams.

The Heart Face Shape

• A rounded shape helps by adding curves to soften the face and emphasizes the lovely heart shape.
• Madonna, Mariah Carey, Julia Roberts

The Long Face Shape

• To make a long face appear oval, one should apply horizontal lines to the face. This draws the eye from side to side and stops it from going up and down.
• A flat brow stops the eye from going up the face.
• Stephanie Seymor, Jennifer Love Hewitt, Claudia Schiffer.

The Square Face Shape

• Strong angled eyebrows balance a strong jaw line.
• The peak of the brow is most effective when directly above the square of the jaw.
• Demi Moore, Paulina Porizkova.

The Diamond Face Shape

Either:

• A rounded brow softens an angular face or
• A peaked brow helps to narrow the width of the typical diamond wide face.
• Sophia Loren, Linda Evangelista.

CONSIDERATIONS IN PERIORBITAL AESTHETICS

In addition to the eyebrow, there are three components of the periorbital area that are typically tailored through the use of eye makeup-the eyelashes, the palpebral portions of the eyelid, and the area between the upper lid crease and the eyebrow.[9][10][11] The proper application of makeup in these areas can often balance such common problems as droopy, bulging, narrow, wide, deep-set, and close-set eyes. Eyeliner is used to dramatize the gentle medial to lateral upward tilt of the classic almond-shaped eye. Eye shadow is often blended differentially to enhance certain areas of the upper lid.

According to Aucoin, “The main principle is that deep colors deepen or hollow an area and light colors bring it forward… to create the illusion of larger, deeper set eyes, I will often blend a slightly darker color into the crease of the eyes.” This technique also accentuates the beautiful transverse curve of the eye.

IMPLICATIONS FOR THE FACIAL PLASTIC SURGEON

For the facial plastic surgeon who performs eyebrow lifting procedures, the interplay between the shape of the face, the eye, and the brow must be clearly understood. The impact of raising the whole eyebrow versus the medial, middle, or lateral portion of the brow must be discussed with the patient to determine what they feel is most attractive. Often this requires educating patients who can appreciate when “things look off” but do not understand the discrete facial dynamics that create a given appearance.

The goals of such discussions are twofold: first, to determine with the patient what changes truly enhance the beauty of the face; and second, to eliminate the gap between expectation and outcome. There is nothing more frustrating to patient and surgeon alike than when a brow lift procedure was a technical success but the patient believes the new brow appearance does not match her face.

The use of digital imaging and morphing programs, such as Alterimage (Seattle Software Design, Seattle, WA), is an excellent way to avoid this problem. Simulated postoperative appearances can be compared and contrasted with preoperative views, significantly narrowing, if not eliminating, the gap between expectation and outcome.

For women who desire their eye to look bigger, such computer programs are also an excellent way to demonstrate the impact of brow shape and position on how large the eye appears. Often the surgeon believes that lifting the brow “opens the eye” and that opening the eye makes it look larger. However, look at Figure [3]. Which oval looks larger, a or b? Cover image b and then quickly alternate between the two images. What you will observe is what artists have known for years. In image a, the line appears thicker and the oval larger than in image b because the oval and line are closer to one another.[12] This visual illusion is also at work when casually observing the periorbital region. Under certain circumstances, lifting the eyebrow can actually give the illusion of creating a smaller eye. Other factors influencing the final appearance of eye size besides eyebrow height include the patient's coloring, the length and width of the brow, and how deep set the eyes are. Finally, the surgeon should have a clear understanding of how the patient likes to wear makeup, as makeup can drastically alter perceived visual relationships.

Figure 3 A test: Which oval appears larger?

THE TECHNIQUE OF ENDOSCOPIC BROW LIFTING

The details of endoscopic brow lifting have been the topic of numerous papers,[13][14][15][16] and an excellent review of the anatomy and basic technique follows in the article by Drs. Quatela and Choe. However, the technique of brow fixation is a point worthy of further discussion and in particular the technique of differential brow fixation. Typically, after endoscopic dissection and elevation of the forehead and brow, surgeons will advance secure the flap using fixation points fairly close to or within the anterior hairline incisions. The advantage of this is that an even distribution of pull is created across the forehead, creating a smooth appearance and uniform brow elevation. However, if a differential brow elevation is indicated, suspension sutures can be endoscopically passed through periosteum and galea within 2 to 3 cm of the brow to elevate specifically either the medial, middle, or lateral aspects of the brow. The sutures are then passed superiorly to be fixated in a traditional manner (bone tunnel, permanent or absorbable screws, or the temporalis fascia).[13][14][15][16] This technique can create bunching of tissue above the suture bites, and additional fixation near the anterior hairline incisions may be required to smooth out the forehead. Although it is more technically challenging, the creation of specific segmental changes in brow shape is consistently achieved with this suturing approach.

CONCLUSION

When counseling patients regarding forehead and brow lifting, the surgeon must understand the goal of surgery in terms of balance and harmonizing the face, not just elevating the brow. The shape of the face and how a patient uses makeup must be considered by both surgeon and patient before determining the best shape and position of each portion of the brow. Should segmental brow lifting be required, targeted suturing techniques can produce the desired nuanced effect.

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