Breaking the Brow into Subunits: Designing a Brow for Cosmetic Improvement

In a previous blog we discussed why low, full brows are sexy, youthful and attractive. In this blog, we will delve into the exact subcomponents of a brow that need to be filled to achieve that look.  I break the brow into multiple points depending on whom I am filling and to what extent in each area.  To summarize some basic goals, I am trying to create visible soft-tissue convexity in just the right areas and to manage areas of depression and bone exposure.  What bone exposure I am talking about is the bone of the orbital rim (think of a skull).  The bone around the eye that starts to become visible over time actually looks quite dreadful and older, and believe it or not but our brains can actually make the distinction between what is soft tissue and what is hard tissue (or bone).

Perhaps the most important area to fill is the lateral brow (the area of the brow outside toward the ear).  When I speak of the brow, I am not talking about the hairy eyebrow but the entire complex of soft tissue that resides between the hairy eyebrow and the upper eyelid.  This soft-tissue convexity when present creates a youthful appearance that captures light beautifully as it bounces off of it.  If you don’t understand this, find a youthful, attractive face and look for this feature that should almost always be present.

Another area of importance is the transition between the brow to the upper eyelid, i.e., the bone line that can be seen as one goes over the upper bony orbital rim.  This shadow of bone to me is very important to soften and to augment so that the concavity and bone exposure is filled in nicely.  Further inward toward the nose (what we call medial as physicians), there can be a dip that looks like an A shape, which we call an A-frame deformity.  This deformity exists in individuals with advanced aging who are very, very hollow or interestingly enough in those who have had traditional blepharoplasty in which a lot of skin and fat have been excessively removed.  Yes, I believe that traditional eyelid surgery can actually age a person further rather than make one look younger.

Deciding what to fill and how much clearly is a decision based on artistry and design that I execute almost on a daily basis.  I use both fat and fillers (temporary and permanent) to create works of art in which individuals look better and more youthful but always look like themselves.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8188. To Learn more about Dr Lams’ plastic procedures or to ask Dr Lam a question please visit his plastic surgery forum