I have partial facial paralysis of the right side of my face due to gillian barrae syndrome as a child. i have recently had a fascia lata sling put in the right side of my face to help make my smile more symmetrical but i have noticed also that one of my eyes is smalller especially when i smile. the surgeon suggested that a open eyebrow lift on the side that is partially paralysed would help open up my eye as well as botox under the eye to correct synkinesis. opionions on these options?
Can an Open Eyebrow Lift Be Performed on Half the Face for Symmetry of a Droppy Eyebrow
Doctor Answers (15)
Asymmetric browlift for facial paralysis
Often elevating the paralyzed side causes a relaxation on the non paralyzed side. That means in your case the left brow is likely to drop slightly in response to the surgery on the right side. You may be surprised to find that the ptosis you have on the left side suddenly lessens when the left brow is elevated for exactly that reason.
The body instinctively elevates both brows to "fix" the problem of a paralyzed brow, and this reflex diminishes when the paralyzed brow is lifted.
Therefore unilateral browlift is a very gratifying operation in a patient with unilateral paralysis.
As pointed out, exact symmetry and function is not possible given the paralysis, and the patient must be OK with that prior to surgery. But improvement is certainly likely with a unilateral browlift, and would be my recommended operation.
Correct Lid Ptosis before Browlift Surgery
With your facial weakness on your right side, your periorbital area has two problems; upper eyelid droopiness (ptosis) and some mild eyebrow sag. Both contribute to making your eye area look smaller on that side. The first thing to do is get your lid ptosis corrected. Only after that is done can you tell if the brow position is worthy of any surgical lifting.
Natasha: I respectfully suggest that the ptosis of your right eyelid contributes more to your eyebrow/eyelid asymmetry than the right eyebrow position. I recommend you correct the lid ptosis and then re-evaluate your appearance. Remember that perfect symmetry not normal and is never a goal.
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I think you have eyelid ptosis
I think you have an issue other than just eyebrow asymmetry. You have ptosis (drooping) of the right upper eyelid. This can be for several reasons. You may just have a droopy lid, it just happens to some people and is pretty common. However, I am suspicous that you may have something that is called aberrant regeneration of the facial nerve. That means that after you developed the weakness on your right side some of the nerve fibers grew back to the wrong location. That could cause your right upper lid to close a little when you smile.
The treatment for a droopy lid depends on the cause. If it is just a droopy eyelid, you can have surgery to help correct the problem. If you have aberrant regeneration of the facial nerve that is more complicated to treat. It can often be treated with a little Botox given to the muscles that close your right eye. However this is a very advanced technique that should be done be somebody experienced with treating that problem.
I would suggest that you see a Neuro-Ophthalmologist or Ophthalmic Plastic Surgeon, to help you find the cause of the ptosis and then consider treatment for that problem before anything is done to your eyebrows.
Facial Paralysis & Eyebrow Lift
Facial paralysis can significantly impact the peri orbital region. Your pictures suggest that you have brow descent, upper eyelid drooping and synkinesis of the lower eyelid. All of these factors contribute to the abnormal shape of your right eye.
It’s difficult to know the relative contributions of each of these factors to your facial asymmetry and how they interact with each other. This explains differences in opinions regarding which problem should be addressed first.
It’s not unreasonable to proceed with unilateral right browlift as an initial maneuver. This will lift the brow in an upward direction and possibly lift the drooping eyelid as well. The synkinesis can be treated with botox. If eyelid drooping persist a secondary procedure can be performed on the eyelid as well.
Brow lift and Botox are great in restoring for facial symmetry
A brow lift is a common procedure in facial paralysis reconstruction for elevating the paralyzed side of your forehead and one that can be very gratifying to both patient and doctor. The alternative is to botox the normal brow to match the heights better. In addition, the brow lift can subtly improve some of the upper eyelid ptosis (drooping) that is contributing to your small eye appearance.
The problem of synkinesis, however, can be a vexing situation. Precise administration of botox can help relax your lower eyelid so that the eye appears to be more open. Make sure the plastic surgeon performing this has a large experience in facial paralysis reconstruction.
Also, I might add that although a static fascia lata sling is a viable option in reconstructing your smile, I would recommend a DYNAMIC option involving free muscle flap reconstruction so that your smile becomes spontaneous. I have personally abandoned the fascia lata sling procedure because the results of a cross face nerve graft and gracilis muscle free flap are so much superior. This is still an option for you.
Unilateral brow lift often performed for facial paralysis
Most types of brow lifts may be performed unilaterally. In the setting of facial paralysis many surgeons favor a direct brow lift (in which a segment of skin is removed) or an endoscopic forehead lift.
I would also agree with Dr. Cohen's comment that your picture seems to show blepharoptosis (eyelid drooping) on th right side.
Many patients who have had facial paralysis develop abnormal, undesired facial movements called synkinesis.
Synkinesis may be contributing to the narrowing of your right eye. A surgeon who is familiar with both ptosis and synkinesis could tell you whether Botox would be a good option to consider, or whether a brow lift might be more helpful.
Mark Lucarelli, MD
Brow lift in facial paralysis
Your surgeon is correct- a unilateral brow lift will help open your eye by pulling up the fascia lata sling that was placed. However, this may lead to asymmetry at another level (brow asymmetry).
Unilateral brow lift for paralysis
A unilateral brow lift can be performed on a side that has paralysis to match the unaffected sisde. Sometimes a direct brow lift is better.
Open eyebrow lift on one side to fix symmetry
You have a very nice result from your sling and your smile looks good. An open eyebrow lift would improve some of the drooping on that side. No one has perfect symmetry. You will still have some asymmetry afterwards but I think you would be happy with the result. Botox is a good choice to correct the synkinesis.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.