Quantifying the Arch Position of the Female Eyebrow

ORIGINAL ARTICLE Quantifying the Arch Position of the Female Eyebrow

James M. Roth, MD; Stephen E. Metzinger, MD, MSPH

Objective: To devise a quantitative aesthetic model for Results: The mean±SD EAP:EW ratio for the fashion mod- the eyebrow arch position (EAP) in women. els was 0.978±0.131; the mean±SD LL:EW ratio was 0.735±0.0673. The mean±SD EAP:EW ratio for the ran- Methods: Full-face frontal magazine photographs of 100 domly selected group was 0.929±0.146; the mean±SD fashion models published between January and July 2001 LL:EW ratio was 0.762±0.0420. were analyzed. Apparent EAP relative to a line through the medial canthus parallel to the midline was compared with eyewidth (EW). A similar comparison was made between Conclusions: The EAP has been described as being the lateral limbus (LL) and the EW. Standardized full-face above the LL. This does not reflect the EAP seen in both frontal photographs of 105 randomly selected women aged of our study groups. The EAP seems to be 93% to 98% 21 to 61 years were taken after obtaining informed con- of an EW in the aesthetic model derived from these sent. The photographs were analyzed in the same manner data. as those of the fashion models. Both populations had the medial and lateral extents of their eyebrows analyzed. Arch Facial Plast Surg. 2003;5:235-239

HE EYEBROW holds a unique Finally, the medial and lateral aspects of quality in the human face. the eyebrow should fall in the same hori- It can help convey expres- zontal plane. Ellenbogen3 and Brennan4 sions such as anger, happi- support this model. ness, sadness, and tired- In 1985, Angres5 introduced an arch ness.T As we age, the eyebrow position may point that differed from this classic model. change with the effects of gravity and sun He believed that the arch point depended exposure, which often can result in people on the amount of space between the eyes. inquiring about ways to make them- Normally spaced eyes, an eye width (EW) selves look younger and more energetic. apart, should have the arch above the pu- Fascination with beauty and eye- pil. Wide-set eyes should have the arch na- brows dates back to early human civiliza- sal to the medial limbus. Finally, close- tion. Johann Wincklemann (1717-1768) set eyes should have the arch above the LL, was an art historian who analyzed the in agreement with Westmore’s model. In ancient Greek’s ideals of beauty. He de- 1987, Tolleth6 made an effort to separate scribed the “eyebrows of grace” as being men and women. He believed that the male “eyebrows that form a delicate arch just eyebrow should be flat, that is, without an above the brow bone. Of particular ap- arch, and that the female eyebrow should peal were eyebrows that grew together, have an arch at the junction of the inner meeting in the midline.”1 two thirds and outer one third of the eye. Westmore2 proposed the more mod- Cook et al7 also departed from West- ern model of the aesthetic eyebrow in 1974 more’s model, believing that the arch above From the Department of (Figure 1). Westmore’s model states that the LL imparted a look of surprise and was Otolaryngology–Head and the highest point of a woman’s eyebrow unnatural. He reviewed what were con- Neck Surgery (Drs Roth and should lie over the lateral limbus (LL). The sidered attractive faces and concluded that Metzinger) and the Division of Plastic and Reconstructive medial portion of the eyebrow should fall the arch should lie more laterally above the Surgery, Department of Surgery in a vertical line with the lateral ala and lateral canthus. The remaining variables (Dr Metzinger), Louisiana the medial canthus. The lateral extent set forth by Westmore remained valid. State University Health should fall in a tangential line connect- Several studies have used computer Sciences Center, New Orleans. ing the lateral canthus and the lateral ala. alterations of the apparent brow and arch

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©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 the nose. The EW was measured by taking the distance between the medial and lateral canthi. A perpendicular line was drawn from the apparent EAP and from the LL to the line drawn between the 2 canthi. The EAP was defined as the highest point along the superior aspect of the eyebrow. A ratio was made between the EAP and the EW as well as between the LL and the EW. All measurements were made using a metric ruler. After obtaining approval for this study from the Louisiana State University Health Sciences Center institutional review board, a group of randomly selected women aged 21 to 61 years had full-face frontal photographs taken by us (J.M.R. and S.E.M.). Participants signed informed consent forms for participation in the study and for the use of their photographs. They completed a survey asking about age, ethnic background, any former surgery, trauma, plucking, waxing, and use of cosmetics. Partici- pants stood 1.2 m from the photographer and had a full-face frontal photograph taken in repose using a 110-mm zoom lens. Measurements were made on these photographs in the same manner as on the photographs of the fashion models. Participants were assigned a number related to their photograph. In both populations, a qualitative assessment of the medial and lateral extents of the eyebrows was made. A horizontal line perpendicular to the line through the medial canthus was drawn from the inferior edge of the medial aspect of the eyebrow across to the lateral aspect of the eyebrow. The lateral extent of the eyebrow was noted to be superior to, inferior to, or within this horizontal plane. The line drawn through the medial canthus was used to see whether the medial eyebrow Figure 1. Westmore’s model of eyebrow aesthetics. lies medial to, lateral to, or within the same vertical plane. Fi- nally, the tangential line was used to see whether the lateral position. Freund and Nolan8 tested the opinions of plas- eyebrow is medial to, lateral to, or within this tangential plane tic surgeons and cosmetologists by using altered photo- (Figure 2). graphs of the same models. Both of these groups agreed that the arch should be lateral to the LL. Gunter and An- RESULTS trobus9 performed a similar study by showing altered photographs to a group of plastic surgeons. All of these plas- The mean EAP:EW and LL:EW ratios for the female fash- tic surgeons preferred a gentle arch that lay somewhere ion models are summarized in Table 1. Of these 100 between the LL and the lateral canthus. Gunter and An- women, 76 were white and 24 were African American. trobus9 also added that the medial brow should be lower One hundred five women aged 21 to 61 years (av- than the lateral brow and should start as a continuation erage age, 35 years) signed the consent forms, com- of the superciliary ridge. pleted the surveys, and had full-face frontal photo- In 1997, Wolfort et al10 also differed from the clas- graphs taken. Seven women reported trauma to the eye, sic model of Westmore. They believed that the arch should eyelid, or eyebrow, including being hit in the face, hav- be halfway between the LL and the lateral canthus. How- ing a small cut in the eyebrow, a broken nose, a second- ever, they agreed that the medial and lateral extents of degree burn due to waxing the eyebrow, and a retinal de- the brow should lie in the same horizontal plane. tachment. Two of these individuals required surgical Although there has been considerable literature about intervention. One person stated that she had undergone eyebrow aesthetics, none of these authors offer a method a blepharoplasty, another had a birthmark removed and for quantifying the eyebrow arch position (EAP), allow- required a skin graft, and 2 had laser surgery to improve ing individual judgment to supersede a quantifiable mea- their vision. Individuals with ophthalmologic surgery for sure. We believe that the arch of the female eyebrow is either visual correction or retinal detachment and those lateral to the LL. Our goal is to quantify the EAP in mod- with a history of a black eye or a broken nose without ern fashion models and a group of randomly selected requiring surgical intervention were included. Individu- women in a simple and reproducible manner. We be- als with significant trauma requiring surgery or who had lieve that describing the EAP in women is a realistic goal cosmetic surgery to the eye, eyelid, eyebrow, or sur- that may help provide a standard for surgical treatment. rounding structure were removed from the study, giv- ing a final number of 100 participants. Of these women, METHODS 65% admitted to plucking their eyebrows or having them waxed; 70% stated daily or regular use of cosmetics to The first part of the study entailed looking at recent fashion maga- the eye, eyelid, eyebrow, or surrounding area; and 65% zines (January to July 2001) for full-face frontal photographs of modern female fashion models. The left eyebrow was analyzed were white, 33% were African American, and 2% were in all cases. A reference line was drawn from the midline point Asian. The mean EAP:EW and LL:EW ratios are sum- between the eyes and the midline of the upper lip. A line paral- marized in Table 1. lel to this was drawn through the medial canthus. A tangential Age assessments of the fashion models could not be line was drawn through the lateral canthus and the lateral ala of made. Of the random group of women photographed, 38

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LB:MB LB:MB MB:MC MB:MC

LB:TL LB:TL

Figure 2. Aesthetic models derived from female fashion models (A) and a group of random women (B). Note the position of the lateral brow to the medial brow in the horizontal plane (LB:MB), the medial brow to the medial canthus in the vertical plane (MB:MC), and the lateral brow to the tangential line in the tangential plane (LB:TL). The eyebrow arch position is drawn at the quantified position. The remaining brow position reflects most brows analyzed.

were aged 21 to 29 years, 35 were aged 30 to 39 years, 16 were aged 40 to 49 years, and 11 were 50 years or older. Table 1. Summary of the EAP:EW and LL:EW Ratios The breakdown of the EAP:EW and LL:EW ratios is given for Both Populations and Subsets* in Table 1. The data generated for each ethnic background (both populations), for those who reported pluck- Group EAP:EW LL:EW ing or waxing vs those who did not, and for those who Fashion models reported daily use of cosmetics vs those who did not are All 0.978 ± 0.131 0.735 ± 0.0673 also summarized in Table 1. White 0.978 ± 0.133 0.733 ± 0.0696 African American 0.973 ± 0.126 0.738 ± 0.0690 A qualitative assessment of the medial and lateral Random women eyebrows was made in both populations (Table 2). All 0.929 ± 0.146 0.762 ± 0.0420 Age, y COMMENT 21-29 0.952 ± 0.156 0.753 ± 0.4060 30-39 0.918 ± 0.107 0.752 ± 0.0448 Our data are mainly from white and African American 40-49 0.942 ± 0.130 0.747 ± 0.5860 Ն50 0.870 ± 0.266 0.766 ± 0.2760 women and may not be accurate for Asian women. The White 0.937 ± 0.146 0.753 ± 0.0443 models of eyebrow aesthetics derived from both popu- African American 0.909 ± 0.150 0.753 ± 0.0402 lations are displayed in Figure 2 and Figure 3. Asian 0.963 ± 0.052 0.764 ± 0.1100 In female fashion models, the EAP seems to be Pluck and/or wax 0.936 ± 0.142 0.750 ± 0.0442 medial to the lateral canthus, or 98% of an EW. The Do not pluck and/or wax 0.917 ± 0.155 0.759 ± 0.0432 lateral brow should be slightly superior to the medial Use cosmetics 0.930 ± 0.155 0.757 ± 0.0446 brow in the horizontal plane, although our study does Do not use cosmetics 0.929 ± 0.124 0.744 ± 0.4160 not delineate how much more superior it should be. Abbreviations: EAP, eyebrow arch position; EW, eye width; LL, lateral The medial extent of the brow should be medial to limbus. directly superior to the medial canthus in the vertical *Ratios are given as mean ± SD. plane, and the lateral extent of the brow should lie in the tangential plane through the lateral ala and the lat- lateral brow was more often found below the medial brow eral canthus. in this population and may be due to age-related changes. In the group of random women, the EAP again seems The medial extent of the brow most often is superior to to be more lateral than suggested by Westmore’s model, the medial canthus in the vertical plane, but the lateral being 93% of an EW. The medial and lateral brows were extent of the brow was more lateral than the tangential most frequently found in the same horizontal plane. The plane in most cases.

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©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 Table 2. Summary of the Position of the Lateral Brow to the Medial Brow in the Horizontal Plane (LB:MB), the Medial Brow to the Medial Canthus in the Vertical Plane (MB:MC), and the Lateral Brow to the Tangential Line in the Tangential Plane (LB:TL)

LB:MB MB:MC LB:TL

Group Superior Same Inferior Medial Same Lateral Medial Same Lateral Fashion models, % 72 24 4 55 42 3 4 62 34 Random women, % 20 48 32 28 61 11 4 40 56

A B C

Figure 3. Eyebrow arch position and qualitative eyebrow position in each aesthetic model: Westmore’s model (A), a fashion model (B), and a random woman (C).

Several physiologic processes can affect the EAP. secondary to loss of visual incentive to keep the eye open The most common process is ptosis of the eyebrow. and others13 believing that it is unchanged in its posi- Lemke and Stasior11 described the physiologic features tion. of eyebrow ptosis in 1982. They described the eyebrow A multitude of surgical corrective procedures and as a specialized area of sliding superficial musculature. types of incisions has been described for raising the eye- It lies superior to where the frontalis and orbicularis brow, including direct browlift,4,14-16 midforehead brow- oculi interdigitate. This area forms a firm attachment to lift,7,14 pretrichial browlift,14 coronal browlift,3,7,14,17 and the underlying bone similar to the nuchal line in the endoscopic browlift.18 Sometimes the brow can be ad- posterior aspect of the skull. This attachment exists dressed as an adjunct to blepharoplasty,3,19,20 and the use especially over the medial aspect of the eyebrow, of botulinum toxin to raise the eyebrows has also been extending laterally approximately half to two thirds the described.21 All of these procedures try to re-create the length of the brow. Because the lateral half to one third common appearance of the eyebrow and to conform to is less densely adherent to the underlying skull, the lat- set eyebrow aesthetics. eral brow is more subject to ptosis. In addition, the The surgical procedures rely on vectors of pull to orbicularis oculi muscle plays the predominant role lat- create a distinct eyebrow arch in female patients. Under erally and pulls down on the eyebrow laterally, which the classic definition, a vector of pull is placed above the has led some authors12 to state the need for more LL to re-create this arch appearance to conform to West- emphasis on correction of the lateral brow than the more’s model. Ellenbogen3 describes vectors of pull to medial brow. re-create Westmore’s aesthetic model in the coronal fore- Ptosis of the brow may be so severe that it can give head lift. Byrd15 describes a vector of pull that achieves a the appearance of blepharochalasis. Most authors4,12,13 more lateral lift in patients with lateral brow ptosis. He stress the need to address the brow in these circum- believes that the lateral vector of pull should follow the stances. Undesirable outcomes may occur if eyelid skin tangential line through the lateral ala and the LL, as this is removed when elevation of the brow is more appro- tries to create an arch or high point at the junction of priate. At the same time, there is controversy over the the medial two-thirds and lateral one-third similar to the role of blepharoplasty and the lowering of the eyebrow, aesthetic model proposed by Tolleth.6 Daniel and Tir- with some authors12 believing that it can lower the brow kantis18 describe a vector more in line with the tangen-

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©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 tial line running through the lateral canthus and the lat- may benefit from trying to clarify how much higher in eral ala through a temporal incision. His lateral incision the vertical plane this variable should be. is often placed above the lateral canthus to help accen- tuate this lateral pull. Our data suggest a more lateral pull Accepted for publication February 26, 2002. to give a further lateral appearance of the arch as the more Corresponding author and reprints: Stephen E. Metz- common appearance seen in fashion models and profes- inger, MD, MSPH, Department of Otolaryngology–Head and sional women. Neck Surgery, Louisiana State University Health Sciences Eyebrow position has been measured in a variety of Center, 533 Bolivar St, Fifth Floor, New Orleans, LA 70112 ways in the past. 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