Eyebrow Manoeuvres

Dimitrije E. Panfilov

The form and position of the eyebrows signalize various moods. Knitted eyebrows and a lined brow betray worry and apprehension. If one eyebrow is lowered and the other raised, this pattern resembles a horizontal question mark and indicates suspicion. Eyebrows drawn obliquely together betray sorrow. A quick movement with the eyebrows is interpreted as a signal of greeting among humans. The lowering of eyebrows is seen as expressing an unpleasant surprise. Wide-open eyes indicate a real surprise. Knitted eyebrows are looking for protection, while tightly closed eyes express revulsion. The eyebrows of a man are bushier than those of a woman. Women pluck their eyebrows to look even more feminine.

Surgical treatment of eyebrow position can harmonize the facial expression. Very often we can see the asymmetric position of eyebrows owing to unilateral hyperaction of the corresponding m. frontalis. This can be corrected through grasping more frontalis fibres on the more elevated side.

If one eyebrow is positioned too deep, it can be elevated by a unilateral endoscopic procedure and unilateral - not central - T-V-plasty.

In bushy male eyebrows, the asymmetry can be reached by asymmetric direct skin excision more over the lower eyebrow.

Procerus Surgery
Fig. 32.1. a Hypertrophic m. procerus and mm. corrugators supercilii and threatening shape of both eyebrows - right more than left. b Harmonizing of glabellar region and symmetrizing

The Brazilian surgeon Antonio Graziosi suggested in 1998 his browlifting with threads without undermining, using minimum incisions. There could be one to three threads per brow as a single procedure or it can be combined with other facial surgeries. Eyebrows have to be suspended to the periosteum behind the hair limit. For a single procedure we need only two instruments: the hollow probe and small Dechamp and one colourless nylon 4-0 suture.

Porfirio Castillo-Campos from Mexico has suggested a hook which is covered with plastified sheet in the middle, so that only the hook itself and the other end expose metal. Through medial or one of the lateral incisions behind the hair limit, this hook can catch either the corrugator or the frontalis muscle.

With electrocautery we touch the outside end of this hook and by pulling on it we divide the muscle partially or totally.

Bibliography

Please see the general bibliography at the end of this book.

of eyebrows by grasping the procerus, corrugators and frontalis - right more than left
Fig. 32.2. a Dermographic planning to elevate the left eyebrow endoscopically and through T-V-plasty. b Symmetrical eyebrow position 3 weeks later. Slight hair loss will recover after 6 months
Achieving Symmetric Eyebrows
Fig. 32.3. a Lower right eyebrow. b Dermographic planning. c Symmetric, elevated eyebrows and "opened eyes"
Fig. 32.4. a Demographic planning. b Only two instruments are needed. c Slight elevation of eyebrow tail. d-g This simple procedure just to elevate the "tail" of the eyebrow is demonstrated in four steps. Notice the slight overcorrection through a tightened suture in step 4 (g)

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