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
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.
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 www.editorialmanager.com/prs/.
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.