The deviated nose and asymmetric eyebrows: an important trap to avoid.

[BACKGROUND] Failure to recognize asymmetrically positioned eyebrows, often altered by the patient to camouflage nasal asymmetry, can lead the surgeon to design the rhinoplasty using a faulty midline landmark. The purpose of this study was to investigate the frequency of eyebrow asymmetry and to test whether there is an association between eyebrow position and the direction of nasal deviation.

[METHODS] Life-size photographs of 100 rhinoplasty patients were selected randomly from the senior author's (B.G.) practice. Nasal deviation from the midpoint of the intercanthal distance was measured at standardized levels on anteroposterior views corresponding to the nasal bones, upper lateral cartilages, and nasal tip. The maximally deviated parameter was noted.

[RESULTS] Of the 27 men and 73 women studied, 96 patients had measurable eyebrow asymmetry, including 96 percent of men and 96 percent of women. All 100 patients had at least one level of nasal deviation. The direction of eyebrow shift correlated significantly with the direction of nasal deviation for nasal bones (p = 0.0018), nasal tip (p = 0.0032), and maximally deviated parameter (p = 0.039), but not for upper lateral cartilages (p = 0.54). Mean eyebrow shift distance for male patients (1.8 mm) and female patients (1.3 mm) was not significantly different (p = 0.056).

[CONCLUSIONS] The frequency of eyebrow asymmetry and the significant correlation between eyebrow position and nasal deviation direction suggest that eyebrows can camouflage nasal deformities. Furthermore, the alarmingly high incidence of nasal deviation in rhinoplasty candidates emphasizes the value of a circumspect preoperative nasal analysis in reducing the incidence of residual postoperative nose deviation.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Risk, IV.