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

Background:  Midpoint of the distance between the medial eyebrows is a common midline reference during the facial analysis for rhinoplasty.  Failure to recognize asymmetrically positioned eyebrows, often altered by the patient to camouflage the nose asymmetry (Figure 1), can lead the surgeon to design the rhinoplasty using a faulty midline landmark.¹

Purpose: This study was designed to investigate the frequency of eyebrow asymmetry and test whether male and female rhinoplasty patients groom their eyebrows to compensate for nasal deviation. 

Methods: Life-size photographs of 100 rhinoplasty patients were randomly selected from the senior author's practice.  Nasal deviation from the facial midline was measured at standardized levels on AP views corresponding to the nasal bones (NB), upper lateral cartilages (ULC), and nasal tip (T), compared to the midpoint of the distance from one medial canthus to the other.  The direction of eyebrow shift was then compared to the direction of nasal deviation.   

Results: The sample population consisted of 27 males and 73 females.  96 patients had measurable eyebrow asymmetry, including 96% of males and 96% of females.  All 100 patients had at least one level of nasal deviation.  The direction of eyebrow shift correlated significantly with the direction of NB deviation (p=0.0018), T deviation (p=0.0032) but not deviation of the ULC (p=0.54).  The direction of eyebrow shift from the midline also correlated significantly with the direction of the maximally deviated nasal parameter (p=0.039).  Mean eyebrow shift distance for males (1.8 mm) and females (1.4 mm) was not significantly different (p = 0.056) between the genders.  

Conclusion: Eyebrow asymmetry is common among both male and female patients with nasal deviation.  The significant correlation between eyebrow asymmetry and nasal deviation patterns in this study suggest that eyebrows are groomed to compensate for nasal asymmetry.  This phenomenon has important implications for rhinoplasty planning.  Using the midline of plucked eyebrows to judge the position of the nose will result in failure to correct nasal deviation.  The midline bisecting the intercanthal distance is a more reliable guide to assess nasal asymmetry as long as the patient does not have a unilateral or bilateral asymmetric orbital dystopia.

Figure 1.  Eyebrow Grooming in Patient with a Deviated Nose