The ideal youthful eyebrow in women has been described as an arch where the brow apex terminates above the lateral limbus of the iris. The medial and lateral ends of the brow should be at the same horizontal, located at or below the supraorbital rim, not above it.

Men have a flatter-shaped, lower-placed brow.⁴

With aging, the gravitational descent of the medial twothirds of the brow is often camouflaged by the reflexive action of the frontalis muscle to counteract upper lid descent. This lid descent results from the senile dehiscence of the levator muscle. Because the lateral aspect of the brow extends beyond the frontalis territory, it descends. As a result, brows often elevate with aging. As described by Garcia and Matros, brow shape may change from an apex lateral slant to an apex neutral position¹ (FIG 2).

Brow lift procedures can raise the brow to positions higher than they existed in youth. Because the medial brow often elevates with aging, exaggerated brow lifts often have an aging effect due to this brow position.^1,2

Over elevation of the brows also tends to decrease upper lid redundancy by exaggerating the hollow eyes of senility and accentuating lid ptosis.²

Removal of the corrugator muscles in an attempt to eliminate glabellar frown lines allows the medial brows to separate and elevate.

Overelevation of the brows may result in an unacceptably high hairline. This may disrupt the proportional balance of the horizontal zones of the face. Hairline elevation can also reflect senility.^1,2

Physical examination should focus on the forehead and periorbital area and its relation to the balance of the face. Analysis should document the height of the forehead, shape and position of the brows, depth of the upper lid sulcus, upper lid position, and levator function.