The hematoma and the forehead weakness may or may not be related

Kenneth D. Steinsapir, MD answers: Concerns after Brow Lift, Midface Lift, and Eyelid surgery

I am a 37-year-old male in pretty decent shape. It is my 24th day post-op from an endoscopic Brow Lift / Midface Lift (I have 4 incisions in my hairline). The doctor pulled/tightened my droopy cheeks and put some fat injections at the cheek bone. I also had upper and lower Blepharoplasty. He only removed the fat from under my eyes (bags), no cuts on lower eyelids.

One side of my eyebrows doesn’t move at all, and the other I can begin to detect SOME movement. The night of surgery, I had a small emergency due to a hematoma needing cauterized on one side of the hairline area (the eyebrow movement problem side). I had to go back into surgery that night to stop the hematoma in my forehead. He drained most of the blood. That part was a horrific experience.

I felt a lot of blood was left in the forehead. It still feels squishy and swollen. Also, my forehead stitches still have not dissolved and there a couple of serious holes/depressions in the hairline where he did the work on both sides. They are still a little painful. I don’t brush my hair there yet. It feels so weird. It is still numb on top of my head; I still feel some tingling in the brow area too. I feel like I need to go see a neurologist just to know what is going on up there.

Will I ever have my eyebrow movement back on that side? I have read that it could be permanent and it is a rare complication. Will the swelling go down more in my forehead? It seems so slow and inflated. Will the holes in my hairline smooth over? When will stitches dissolve?


Kenneth D. Steinsapir, MD
5 months ago

Dear GRod

Hematomas happen.  A Hematoma is a collection of blood under skin.  There is often significant bruising associated with the process as well. It is a risk of having any surgery. They can profoundly delay healing so your doctor did the right thing and acted to control the hematoma.

So it is not surprising that your healing process is sputter along.  You will get there but it takes much longer under these circumstances.

The muscle paralysis you are describing can be permanent if the nerves were damaged during surgery.  However, the bruising and swelling associated with the hematoma can be associated with motor nerve dysfunction that slowly resolved as the swelling goes down.  This can take place over several months.  However, in my experience, whatever function has not returned in 6 months represents a permanent deficit.  With the forehead lift these types of motor deficits can be relatively subtle even if the weakness does not recover.

As noted by others, some degree of hair root shock is common around the incisions used for the forehead lift.  Typically, the hair begins to regrow at these sites after a few months.  I have never had a person require scar revision for one of these incisions.  Over time they tend to do quite well.

Honestly, I am not sure that seeing the neurologist will do you a bit of good.  Mostly, you need time to heal.  Three weeks is a very short time frame.

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