Eyebrow asymmetry: ways of correction.

Ocassionally a patient asks for correction of his asymmetric eyelids. In many instances, however, a careful analysis reveals that the actual cause is an asymmetry of the eyebrows. Generally, asymmetric eyebrows are due to excessive muscle dynamics (i.e., a hyperkinesia of the frontalis or the depressor supercilii muscles). Therefore, the asymmetry will not be corrected by an asymmetric blepharoplasty, which will instead disclose the preexisting asymmetry, much to the concern of the patient. Management of the asymmetric brow is demanding and requires a preoperative problem-oriented and detailed analysis of the individual patient to achieve satisfactory results. We present 10-years' experience using a problem-specific approach. This included intramuscular botulinum toxin A injection, superselective neurotomy, endoscopic browlift and traditional procedures such as the coronal and direct browlift. Indication, patient selection, results, and complications are discussed.