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Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Procedures :: Surgical

height of the eyebrow is greater than 7cm, consideration should be given to procedures to lower the line of hair implanting.

The masculine eyebrow should be positioned within or immediately below the supraorbital rim and should be horizontal or have a straight setting (Figure 17.5). It is thick and should be slightly tapered, from the medial to the lateral position. The excessive activity of the corrugator muscles and the procerus muscles may lead to an irritated, worried or tired appearance due to the wrinkles of the glabellas.

typical masculine eyebrows - figure

Figure 17.5 Typical masculine eyebrows.


When examining the masculine eyebrow it is important to take the glabellas into consideration, seeing that, often, are of greater interest than the vertical height of the eyebrow.

DIAGNOSIS AND SELECTIONS OF SURGICAL PROCEDURE

When examining the patient, it is important to take into consideration the patient’s tendency of unconsciously raising the eyebrows when looking into a mirror or when posing for a photograph. Therefore, it is crucial that the patient closes his eyes or relaxes the eyebrows. Thereafter, the eyebrows should be stabilized while at rest with the hands of the examiner, so that, when patient opens his eyes, the true position of the eyebrows will be revealed.

Other important factors to consider in the assessment of the patient include the height of the eyebrow, the folds of the aesthetic eyebrow, glabella wrinkles, skin thickness, and direction of the forehead, male-pattern baldness, eyebrow asymmetry, hair implant line and the preferred hairstyle.2 The general purpose of the surgery should be the reduction of wrinkles on the forehead, lateralization and elevation of the medial segment of the eyebrow and the possibility of changing the shape and position of the eyebrow when desired.

Patients with a low hair implant line are treated best with a procedure that will hide the incision and will elevate the hair implant line, with a coronal or endoscopic frontal lift. The quality and texture of the hair should be taken into consideration. The coronal incisions are better hidden in patients who have lighter and finer hair, in such that the hair falls downwards, that there is no important demarcation line between the skin with hair and the hairless skin,. The endoscopic lift is generally more suited to patients with thick hair, a low hair implant line and few dynamic wrinkles. Even male patients with male-pattern baldness can be considered for the endoscopic procedure, because the incisions heal well.

Patients who have a high hair implant line are suited to the use of different techniques. These include, amongst others, the pretechial /trycophytic , bi-plane, mesofrontal, threaded endoscopic, temporal, direct transbelapheroplasty and suture suspension procedures. Some of the procedures mentioned will not be discussed, seeing that they have not been performed, nor necessarily recommended by the authors.

In patients with a suitable hairstyle that helps camouflage the incision and removal of the wrinkles on the forehead, a pretrechial / trycophytic procedure can be taken into consideration.

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