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

Bruneau, Stéphane M.D.; Foletti, Jean-Marc M.D.

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Plastic and Reconstructive Surgery: November 2016 - Volume 138 - Issue 5 - p 941e-942e
doi: 10.1097/PRS.0000000000002729
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We thank the authors for their interest in our work. In our article,1 no measurements were performed referring to the lateral canthus, whose position is variable in time. All measurements are taken with reference to the intercanthal line, the horizontal line passing by the two medial canthi (En-En), regardless of the lateral canthi. We chose this landmark precisely because it does not change with aging.2 This methodology avoids measurements between two mobile landmarks, which would bias our results. As pointed out by Odunze et al.,3 there are many variations in anthropometric standards and history of facial aging from one ethnic group to another.

We deliberately chose to include only Caucasian subjects in our sample, to make it more homogeneous, and to limit sources of interindividual bias. However, we designed our protocol to be reproducible, precisely to be able to apply it to other samples of any population, allowing their comparison on validated objective data.

It is commonly admitted that the tone of the frontalis muscle influences the eyebrow position. We have integrated this factor into our analysis with forehead line severity evaluation. Our results support an increase with aging of this tone. We have deliberately chosen not to antagonize this tone (manually or with botulinum toxin injection) for our measurements to avoid altering the natural eyebrow position.

Our study does not question an increasing laxity of the upper third of the face with aging. We described its physiologic muscular compensation, which results in the stability of the eyebrow position for years.

We would like to thank the Journal for allowing us to enhance the debate about the aging eyebrow. We sought to afford a better understanding of the physiologic aging of the upper third of the face. A better distinction in our operative indications may help us to obtain better and more natural results.


The authors have no financial interest to declare in relation to the content of this communication.

Stéphane Bruneau, M.D.
Jean-Marc Foletti, M.D.
North University Hospital
Marseille, France


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.


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