Journal Logo


Does the Eyebrow Sag with Aging? An Anthropometric Study of 95 Caucasians from 20 to 79 Years of Age

Teven, Chad M. M.D.; Few, Julius W. M.D.

Author Information
Plastic and Reconstructive Surgery: November 2016 - Volume 138 - Issue 5 - p 941e
doi: 10.1097/PRS.0000000000002708
  • Free


We read with great interest the article “Does the Eyebrow Sag with Aging? An Anthropometric Study of 95 Caucasians from 20 to 79 Years of Age” by Bruneau et al.,1 and applaud their valuable addition to the literature on the subject of eyebrow position and aging. As the authors note, the eyebrow has long been considered a pivotal structure in facial aesthetics. Numerous studies have attempted to establish ideal criteria for eyebrow position and characterize changes of the eyebrow during the facial aging process.2 However, results have been disparate and a consensus on normal eyebrow position and how it relates to facial aging has yet to be reached. In an effort for further clarification, the authors provided a thought-provoking study aimed at evaluating eyebrow position in various age groups. Despite the study’s compelling results that eyebrow position is stable during aging, we have identified several issues that warrant further discussion.

In the current study eyebrow height was evaluated by measuring the vertical distance between the upper eyebrow margin and a horizontal reference line (intercanthal line) at four points: medial canthus, iris center, lateral sclerocorneal limbus, and lateral canthus.1 No significant differences were found when comparing eyebrow height at any of these points between the three age groups (20 to 39, 40 to 59, and 60 to 79 years of age). Although we agree that medial and central eyebrow height may remain stable, it is less clear that the relative height of the lateral brow does. We have previously demonstrated that lateral canthal complex descent is a significant component of periorbital aging.3 Therefore, one would assume that as the lateral canthal complex descends during aging, the relative height of the lateral brow would increase. We would ask that the authors provide an explanation as to the discrepancy of these findings.

An additional issue lies in the fact that only Caucasians were included. Ethnic considerations have become increasingly important in aesthetic plastic surgery. Price et al. found that race, gender, and age differences exist for eyebrow position.4 Specifically, African American eyebrow height was increased relative to Caucasian eyebrow height regardless of age, and older African American men had significantly increased eyebrow height relative to younger African American men. Although we understand that the demographic makeup of the local population dictates whether certain populations of patients can be studied, it would be interesting if Bruneau et al. found that their results were applicable to non-Caucasian individuals as well. Indeed, it is incumbent on all of us to further characterize the extent to which ethnic differences affect eyebrow position and facial aging.

Another important consideration is static versus dynamic assessment. The authors do not address compensatory position of the brow, something that is critical in ophthalmic plastic surgery. Experience with botulinum toxin has shown that perceptions of brow positioning can be dramatically altered cephalad or caudad.5 We therefore suggest that a true change in brow positioning is likely present but compensated by resting frontalis tone, and immobilization of this tone would have yielded different study results. Finally, we thank the Journal for bringing this important topic to light and feel its great value can be enhanced by the caveats reviewed above.


The authors have no financial relationships to disclose with respect to this communication.

Chad M. Teven, M.D.
Julius W. Few, M.D.
Section of Plastic and Reconstructive Surgery
University of Chicago Medicine
Chicago, Ill.


1. Bruneau S, Foletti JM, Muller S, Vercasson C, Lauwers F, Guyot L. Does the eyebrow sag with aging? An anthropometric study of 95 Caucasians from 20 to 79 years of age. Plast Reconstr Surg. 2016;137:305e312e.
2. Matros E, Garcia JA, Yaremchuk MJ. Changes in eyebrow position and shape with aging. Plast Reconstr Surg. 2009;124:12961301.
3. Odunze M, Rosenberg DS, Few JW. Periorbital aging and ethnic considerations: A focus on the lateral canthal complex. Plast Reconstr Surg. 2008;121:10021008.
4. Price KM, Gupta PK, Woodward JA, Stinnett SS, Murchison AP. Eyebrow and eyelid dimensions: An anthropometric analysis of African Americans and Caucasians. Plast Reconstr Surg. 2009;124:615623.
5. Maas C, Kane MA, Bucay VW, et al. Current aesthetic use of abobotulinumtoxinA in clinical practice: An evidence-based consensus review. Aesthet Surg J. 2012;32(Suppl):8S29S.


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

Copyright © 2016 by the American Society of Plastic Surgeons