Purpose

To present a novel case of an eyebrow lowering Z-plasty transposition flap for brow asymmetry due to cicatricial vectors from prior Mohs surgery.

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Methods

Case: A 52-year-old female patient presented with cicatricial elevation of the lateral right brow following prior Mohs surgery to treat a basal cell carcinoma with a large defect of the lateral right forehead. While the cancer was cured, the resective surgery resulted in permanent elevation of the right brow tail with disfiguring asymmetry. The lateral supra-brow forehead tissue demonstrated scarring and fibrosis with immobility. The patient desired reconstructive surgery to achieve brow symmetry. Herein, we describe a Z-plasty transposition flap for lowering of the brow position.

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Results

Surgical Technique: On the right brow a Z-plasty was designed with a surgical marking pen incorporating the brow tail with the goal of lowering the lateral brow position. Flaps were created and elevated with a blade and scissors. Care was taken not to disrupt the hair follicles. The flaps were then transferred in an adjacent tissue transfer technique into the appropriate position. The Z-plasty flaps were secured with deep sutures and the skin was closed with superficial interrupted sutures. The entire tail of the brow was noted to be in improved position.

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Conclusion

Conclusions: Reconstructive repositioning of the over-elevated eyebrow presents a surgical challenge, particularly in cicatricial cases that lack supple forehead tissue or laxity. A Z-plasty transposition flap technique offered an effective method of lowering of the eyebrow position in the complex cicatricial case. The surgery demonstrated an excellent functional and aesthetic result with improved eyebrow symmetry and patient satisfaction.

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Additional Authors

First name	Last name	Base Hospital / Institution
Daniel	Azzam	University of California, Irvine
Jeremiah	Tao	University of California, Irvine

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