The Perfect Brow

By Dr. Steven Pearlman

Eyebrows frame the face and have been one of the traceable hallmarks of facial beauty through the ages. Beauty is defined by magazines and movies, so when I want to demonstrate what the perfect brow looks like to a patient, the first thing I do is open a fashion magazine and flip through the ads and editorial pages, not plastic surgery textbooks. I was lucky to have attended the book opening of "The Eyebrow" by Robyn Cosio (2000, Harper Collins, New York, NY). This is a superb treatise tracing evolution of the eyebrows through the 20th century from the thin arched brows of the flappers in the early 20's to the full post war eyebrows of the 50's to the restoration of the 40's "diva arch" in the 90's.

Makeup artists and aestheticians have long understood what makes the perfect brow; club shaped centrally then tapering along the tail with the center portion beginning at a vertical line drawn upward from the edge of the nostril. The tail extends to a line that runs from the corner of the nose through the corner of the eye. The height of the brow should be equal at both ends; typically at or just above the rim of the eye socket. Generally, in women, the brow should arc delicately with the highest peak between the corner of the iris and the corner of the eye. The male brow should rest on or at the rim of the eye socket and is more horizontal in shape. Aestheticians commonly employ the "pencil trick" to guide them in eye shaping using a pencil shaped brow stick to delineate the parameters above.

The skin portion between the brow and the eye should be smooth and have a youthful fullness, with little excess skin and no over-hang of the skin. This leaves a nice platform to apply eye shadow without flaking or cracking.

All the above is well and good for teens and models, but as we age, the brow may flatten and droop as well as deflate. Before even considering cosmetic surgery, a skilled makeup artist can often shape a brow to mimic a youthful arch.

There are a number of non-surgical as well as surgical techniques to rejuvenate an aging eyebrow. Eyebrows can be elevated non-surgically by the use of expertly placed Botox. Not only can eyebrows be lifted, but shaped as well. Crow's feet can also be smoothed. Sometimes it's more a deflation of the eyebrow instead of drooping. In that case, fillers such as Restylane or Juvederm can be used to restore youthful fullness that appears like a browlift but actually doesn't lift the brow.

When is surgery necessary? When there is significant wrinkling and redundancy of the eyelid skin, which may be due to excess skin or drooping of the eyebrows. If the brows are in good position and the overhanging skin doesn't extend far beyond the corner of the eye, a blepharoplasty (eyelift) is the best solution. When the excess skin goes well past the eye, that means that the brow has dropped; a browlift is more helpful. Another way to tell if its brows or eyelids that are the problem: if you look worried, sad or angry it's more likely due to a brow problem. If you look tired it's usually more from the eyelids. Another way is to pull out photos of yourself from your mid 20's, and check where your eyebrows once were. Be careful when you see a plastic surgeon. I now do far fewer browlifts then before. In my opinion, brows are too often lifted excessively or when it wasn't necessary at all. Remember, its' about shape not height.


More about Dr. Pearlman...

Dr. Steven Pearlman's plush Park Avenue facility, with its atmospheric amber ambiance, accented with smart floral arrangements and AAAHC-Certified on site operating room, is almost as attentive to a patient's equilibrium as Dr. Pearlman himself. A prominent facial plastic and reconstructive surgeon, humanitarian, and educator, Dr. Pearlman's accolades are enough to make consummate surgeons blush. It is his commitment to his patients' needs, however, that keep Dr. Pearlman humble, focused and eager to start his day.

On a technical level, Dr. Pearlman has the agility and ability of the most seasoned and steady hand in his trade. He is dual board certified in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery. From traditional facial fillers to the future of laser therapies, Dr. Pearlman's skin savvy is always en vogue. His work spans the gamut of invasive and non-invasive procedures, including: blepharoplasty (eyelid lift), facelifts, facial implants, forehead lifts, rhinoplasty, revision rhinoplasty - procedures for which he is renowned - IPL rejuvenation, laser skin resurfacing, lip augmentation, skin care and Botox. His peers, witness to his perpetually proven ingenuity, elected him President of the American Academy of Facial Plastic and Reconstructive Surgery, 2004-2005.

The personalized attention doesn't stop at top-notch cosmetic and reconstructive surgery. From consultation to recuperation, Dr. Pearlman ensures his patients' needs are tended to in ultimate comfort and unparalleled care. Dr. Pearlman schedules limousine service to and from his office, arranges recovery time at nearby hotels, and even provides the services of his visiting nurses to attend to patients' post-operative needs. Part cosmetic and reconstructive surgeon, part travel agent, part humanitarian, part teacher, Dr. Pearlman is all-encompassing when it comes to providing his patients the most positive cosmetic and reconstructive experience on the East coast.

When he finds time between his wife, newborn twins, employees and patients, Dr. Pearlman gets involved in pro-bono humanitarian efforts. Face to Face, an international surgical exchange program that offers individuals the chance to overcome physical limitations imposed on them by circumstances beyond their control, has led Dr. Pearlman to China, Honduras, and Vietnam to treat children and educate fellow surgeons. He also takes part in the National Domestic Violence Project, which helps victims of domestic abuse receive surgical treatment from their injuries.


Academics & Abridged CV:

After graduating in 1978 from Brandeis University Magna Cum Laude with a BA in biology, Dr. Pearlman plunged headlong into his medical studies at The Mount Sinai School of Medicine in New York. After graduating, he completed his residency in head and neck surgery in 1987, again from Mount Sinai. Following his residency, Dr. Pearlman pursued a highly sought fellowship in facial plastic and reconstructive surgery at St. Luke's/Roosevelt Hospital. Not long after completing the fellowship, Dr. Pearlman, committed to personally overseeing attentive patient care, opened his own practice.

In 1993, Dr. Pearlman founded the New York Facial Plastic Surgery Society to promote advanced education for facial plastic surgeons in the New York Metropolitan area; it also serves as a soundboard for practicing physicians to exchange ideas, new techniques and procedures on an ongoing basis. He is Director of the Division of Facial Plastic Surgery at St. Luke's-Roosevelt Hospital. In addition, he is an attending surgeon at both Lenox Hill and Manhattan Eye Ear and Throat Hospitals.

Teaching Credits:

Dr. Pearlman is a Clinical Associate Professor at Columbia University College of Physicians & Surgeons, a title awarded based on teaching and medical publications, and he often teaches residents facial plastic surgery at Columbia University School of Medicine and New York University. Dr. Pearlman is often invited to lecture as a visiting professor and presenter on the latest advancements in cosmetic and reconstructive surgery throughout the continental United States, as well as abroad. His findings appear in various medical textbook chapters and articles on rhinoplasty, revision rhinoplasty, facelift surgery, blepharoplasty, endoscopic facial surgery, laser skin resurfacing, and sinus disease.

Board Certification:

American Board of Facial Plastic and Reconstructive Surgery
American Board of Otolaryngology - Head & Neck Surgery

Professional Organizations:

President of the American Academy of Facial Plastic and Reconstructive Surgery, 2004-2005, the world's largest specialty association that represents over 2,700 facial plastic and reconstructive surgeons throughout the world. He is the founding President of the New York Facial Plastic Surgery Society. He has also served as Eastern Region Vice President and National Committee Chairman for many committees of the AAFPRS.