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The Deviated Nose and Asymmetric Eyebrows: An Important Trap to Avoid

Katira, Kristopher M.D.; Guyuron, Bahman M.D.

Plastic and Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 519–523
doi: 10.1097/
Cosmetic: Original Articles

Background: Failure to recognize asymmetrically positioned eyebrows, often altered by the patient to camouflage nasal asymmetry, can lead the surgeon to design the rhinoplasty using a faulty midline landmark. The purpose of this study was to investigate the frequency of eyebrow asymmetry and to test whether there is an association between eyebrow position and the direction of nasal deviation.

Methods: Life-size photographs of 100 rhinoplasty patients were selected randomly from the senior author’s (B.G.) practice. Nasal deviation from the midpoint of the intercanthal distance was measured at standardized levels on anteroposterior views corresponding to the nasal bones, upper lateral cartilages, and nasal tip. The maximally deviated parameter was noted.

Results: Of the 27 men and 73 women studied, 96 patients had measurable eyebrow asymmetry, including 96 percent of men and 96 percent of women. All 100 patients had at least one level of nasal deviation. The direction of eyebrow shift correlated significantly with the direction of nasal deviation for nasal bones (p = 0.0018), nasal tip (p = 0.0032), and maximally deviated parameter (p = 0.039), but not for upper lateral cartilages (p = 0.54). Mean eyebrow shift distance for male patients (1.8 mm) and female patients (1.3 mm) was not significantly different (p = 0.056).

Conclusions: The frequency of eyebrow asymmetry and the significant correlation between eyebrow position and nasal deviation direction suggest that eyebrows can camouflage nasal deformities. Furthermore, the alarmingly high incidence of nasal deviation in rhinoplasty candidates emphasizes the value of a circumspect preoperative nasal analysis in reducing the incidence of residual postoperative nose deviation.


Cleveland, Ohio

From the Department of Plastic Surgery, University Hospitals Case Medical Center.

Received for publication June 7, 2013; accepted October 2, 2013.

Presented at Plastic Surgery The Meeting 2013, 82nd Annual Meeting of the American Society of Plastic Surgeons, in San Diego, California, October 11 through 15, 2013; the 18th Annual Meeting of the Rhinoplasty Society, in New York, New York, April 11, 2013; and the 56th Annual Ohio Valley Society of Plastic Surgeons Meeting, in Indianapolis, Indiana, May 17 through 19, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Bahman Guyuron, M.D., 29017 Cedar Road, Cleveland, Ohio 44124,

©2014American Society of Plastic Surgeons