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IntroductionThe use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators.MethodsA retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient.ResultsOut of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid.ConclusionTranspalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis.Level of Evidence IVThis 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This study evaluates the combined approach of lateral temporal subcutaneous brow lift (LTSBL) and upper blepharoplasty to improve both brow and eyelid aesthetics. An analysis was conducted on 28 female patients (mean age: 47 ± 6.3 years) who underwent the combined procedure between January 2023 and September 2024. Preoperative and postoperative photographs were analyzed using Westmore’s ideal eyebrow measurements. Satisfaction was assessed with a visual analog scale (VAS) questionnaire. The combined surgery demonstrated significant improvement in brow positioning. Follow-up was conducted at an average of 11 ± 2 months (range: 3–13 months) to assess the mid-term stability of brow position. The A-C line (lateral brow) showed a 50% improvement, increasing from 46 mm (SD ± 4.6) to 71 mm (SD ± 5.1) ( p  = 0.02). The D-E line (brow apex) improved by 45%, from 35 mm (SD ± 5.6) to 50.75 mm (SD ± 4.5) ( p  = 0.04). Horizontal alignment (B-C) improved by 25%, contributing to overall brow symmetry. Patient satisfaction was high, with 89% expressing satisfaction and 11% reporting high satisfaction. Combining LTSBL with upper blepharoplasty provides comprehensive periorbital rejuvenation, addressing lateral brow ptosis and upper eyelid excess. This technique offers high aesthetic satisfaction with minimal complications, making it an effective option for patients seeking enhanced upper facial harmony.

Purpose To measure the changes of the eyebrow’s contour after frontalis muscle (FM) contraction. Methods Two consecutive pictures of the eyes and frontal region of 36 volunteers (15 men and 21 women) were obtained with the forehead relaxed and upon maximal frontalis muscle contraction. Bézier lines representing the brows’ contours, obtained with the ImageJ software, were graphically sampled with a resolution of 0.025 mm. The contours of the relaxed and elevated brows were compared regarding the position of the contour peak (CP), the degree of elevation of brow central point, and the medial and lateral areas outlined between the brow contours before and after frontalis contraction. The asymmetry of the brow contour after FM contraction was calculated by the Naeije formula as (Medial–Lateral)/(Medial + Lateral). A difference of 10% or less between the lateral and medial areas was taken as a cutoff value for symmetrical brow elevation. Results In 62 (86.1%) of the eyes, the location of the brow’s CP was lateral to the brow’s midpoint. When the brows were raised, the CP of 60% of the brows was displaced medially and 40% laterally. The motion of the CP with medial displacement (mean = 3.7 mm) was significantly larger than those displaced laterally (mean = 1.9 mm) decreasing the number of brows with lateral peaks from 62 (86.1%) to 54 (75%). No difference was observed between the mean elevation of the central point of the brow for males (7.9 mm (3.2 SD) and females (7.4 mm, 3.0 SD). In 58.3% of the sample, the positional change of the medial and lateral sectors of the brows was symmetrical, and among the 41.7% asymmetrical cases, the elevation of the medial side was higher than the lateral in 66.7% of the brows. Conclusions The brow changes during FM contraction concur well with the anatomic data of the FM shape. The contour of most brows is displaced toward the medial direction when the brow is elevated. The pattern of brow shape change is an indication of the FM anatomy and must be carefully analyzed before any procedure involving the FM, such as chemodenervation injections or frontalis slings for blepharoptosis correction.

BackgroundSome of the surgeons performing endoscopic brow lift believe that this technique does not lead to clinically significant enlargement of the forehead.PurposeThe goal of this study is to determine the change in eyebrow and forehead height after endoscopic brow lift and to assess the durability of the result over time.MethodsThe pre- and postoperative photographs of 97 patients who underwent endoscopic brow lift from January 2016 to July 2020 were standardized and analyzed. The distance between median hairline and upper edge of eyebrow, the distance between upper edge of the eyebrow and edge of the lower eyelid and the distance between edge of the lower eyelid and the nasal base were measured, and the change in the upper face proportion was measured and analyzed.ResultsThere was statistically significant brow elevation after endoscopic brow lift in all three time periods (less than 1 month, 1–6 months and greater than 6 months). Forehead height did not change to a significant degree, while eyebrow height was increased statistically significant. A longitudinal study on 14 patients for whom multiple follow-up data were available showed that the increase in periorbital height appears to be sustained over time, whereas the change in the forehead height is not as readily apparent, resulting in a bigger relative change in the periorbital compared to the forehead height.ConclusionsThe brow height increased more than the forehead height, corroborating the fact that most of our patients have not complained about forehead becoming larger.Level of evidence IVThis 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The concept of facial aesthetic has been around for centuries, popularised in the Renaissance period by artists such as Da Vinci. The eyebrow is also known as the master line of the face and is used as a reference for other facial angels and contours. The criterion of the aesthetically pleasing eyebrow has been a subject of much debate over the years, ever since make-up artists such as Westmore described the modern concept of the ideal brow in the 1970s. The concept of the ideal brow has evolved over the decades, subjected to influence by cultural trends and differences. This narrative review aims to examine the current evidence in the literature with regard to the ideal eyebrow from an aesthetic point of view, taking into account gender, age and ethnic differences. A set of guidelines are also proposed in order to help clinicians tailor the appearance of the eyebrow to individual patients based on the author’s personal opinion.Level of Evidence V 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Narrowing of the distance between the eyes and eyebrows is commonly observed after subbrow blepharoplasty. The purpose of this study was to quantify the changes in brow-lid distance after subbrow blepharoplasty in Asian women. Methods We observed and standardized the pre- and postoperative photographs of 63 patients who underwent subbrow blepharoplasty from January 2020 to October 2022. We measured the distances from the medial and lateral eyebrow to the lower lid margin on the right side of the face and then analyzed the changes in postoperative brow-lid distance using the standard iris diameter for Asian women of 11.5 mm as a reference. Results Photographs of 63 patients were included in the study. All 63 patients were females. The average postoperative distance of the lateral eyebrow to the lower lid margin was 30.08 ± 2.74 mm, a significant decrease in comparison to the preoperative distance (31.84 ± 2.65 mm) ( P  < 0.001). The mean postoperative distance of the medial eyebrow to the lower lid margin was 25.84 ± 2.87 mm, compared with that of the preoperative distance (27.59 ± 2.94 mm), which was a significant decrease ( P <0.001). All 63 patients (100%) had a decrease in the lateral eyebrow distance, while 59 (93.65%) had a decreased medial eyebrow distance. Conclusions There was a statistically significant change in brow position, consistent with our observations. Subbrow blepharoplasty can cause a decrease in the distance between the eyebrows and eyes. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BackgroundSupra-brow and sub-brow blepharoplasty are two types of upper eyelid blepharoplasties that are commonly performed in middle-aged Asian women to correct skin laxity of the upper eyelid; the postoperative scar formation of the two procedures may be different. Therefore, we designed this retrospective study to explore the differences in postoperative scarring between patients receiving supra- or sub-brow blepharoplasty.MethodsWe identified 52 patients who underwent supra-brow blepharoplasty and 54 patients who underwent sub-brow blepharoplasty. For each patient, the scar quality was assessed using photographs, the Observer Scar Assessment Scale (OSAS), and the Patient Scar Assessment Scale (PSAS) 1 year following surgery.ResultsFor OSAS, higher scores for pigmentation, thickness, relief, pliability, surface, and overall opinion were observed in patients who underwent supra-brow blepharoplasty (p < 0.05) except for the “vascular score” (p = 0.148). The average overall opinion scores of the supra- and sub-brow blepharoplasty were 3.90 ± 0.41 and 2.33 ± 0.48, respectively, indicating that acceptance of postoperative scars in patients who underwent supra-brow blepharoplasty was worse than that in patients who underwent sub-brow blepharoplasty. Significantly higher scores were observed in all items of PSAS items for patients with supra-brow blepharoplasty (p < 0.05).ConclusionsThe postoperative scars in patients who underwent supra-brow blepharoplasty were more obvious than those in sub-brow blepharoplasty. From the perspective of postoperative scar formation, sub-brow blepharoplasty may be a more suitable choice for patients.Level of Evidence VThis 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Eyebrow region is a dynamic region, and it has a thinner skin prone to wrinkles and sagging. Descended brows could be repositioned immediately with fewer complications by the use of the threads. Despite all its advantages, the main drawback of absorbable thread lift is its short duration of lifting effect. Aims This report aims to describe our thread lift technique we have implemented to counteract the descent of the brows and evaluate our results in 50 patients. Patients/Methods A retrospective chart review was carried out over a period of 1 year from September 2019 to 2020 for the patients who underwent thread lifting for eyebrows in a private clinic in Ankara. Complications after the procedure, durability of the results, global esthetic improvement scale (GAIS) score, and patient satisfaction survey scores were recorded. Results The study group was composed of 50 female patients with a median age of 34 years. The median duration of the procedure is 15 months. Nine (18%) patients experienced complications related to the procedure including ecchymosis, edema, erythema, skin dimpling, and pain. Three weeks after the procedure, the position of the eyebrows of eight (16%) patients were improved, 18 (36%) patients were much improved, and 24 (48%) patients were very much improved according to GAIS. Conclusions So far, the most disappointing feature of the threads was the poor long‐term sustainability of the outcomes. Our thread lift technique for brows offers a significant improvement in the position of the eyebrows in a short time with decreased downtime. More importantly, it can be possible to improve the longevity of the results with this approach.

Background Eyelid surgery is a cosmetic procedure performed worldwide in the field of plastic surgery. However, achieving optimal outcomes for the upper eyelids presents a challenge, necessitating careful patient selection and appropriate surgical choices. Objectives This article aims to provide recommendations for selecting the most suitable surgical procedure among three commonly performed treatments for aged upper eyelids. Methods A retrospective cohort study was conducted from October 2020 to May 2022, involving 518 patients. Pre- and postoperative photographs were analyzed to evaluate changes in the distance between the eyelids and brows. Notably, patients who habitually use the frontalis muscle to manage upper eyelid redundancy showed significant variations in the lid-brow distance after eyelid surgery. Results The study confirmed that addressing skin laxity through upper blepharoplasty or infra-brow excision reduced the stimulus for frontalis activity, resulting in true brow ptosis. However, the degree of compensatory frontalis movement differed among individuals, and changes in the lid-brow distance observed before and after the photos were influenced by various factors. As a result, obtaining clear numerical data regarding the changes in the lid-brow distance following eyelid surgery proved challenging. Nevertheless, after analyzing 518 cases, the author has classified the patients into three groups, which can contribute to more predictable and satisfying outcomes. Conclusion Based on the analysis of pre- and postoperative results from 518 patients, this study recommends specific strategies to enhance patient satisfaction. The proposed treatment algorithm may assist beginner surgeons in avoiding angry or tired-looking eyes after periorbital rejuvenation. Level of Evidence V 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. Objective We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. Methods A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30–90 days postoperatively and analyzed with ImageJ software. Results Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45–3.33 mm, respectively. Conclusion Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. Level of Evidence II 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .