Eyebrow Droops After Mini-lift. Doc Suggesting Botox? (photo)

I had a mini face lift 4 days ago. My lower face looks great (still swollen), but my right eyebrow now droops! It is frozen and I can't move it up. I am very frightened. My board certified PS said when I come in to have my stitches removed next week he will evaluate me and try botox to lift it till the nerve heals. But I am concerned about how this would even work if the muscle is already immobile! What is your professional opinion on this? See my photos.

Update: On April 11, 2012 I had a mini or lower facelift. I posted on RealSelf at that time that right afterwards my right eyebrow drooped down and I could not raise it. I asked my PS if a nerve had been cut. He said when he did the incision in my temple, I had a blood vessel that was in a place where most people do not have it. It was accidentally nicked. He cauterized the vessel, which was very close to a nerve that controls the eyebrow movement. Nerve was traumatized by the heat. After 2 mos, OK.

Doctor Answers (7)

Pretty early after surgery.

+2

You are definitely demonstrating a right frontal nerve injury.  At 4 days I would not be overly concerned about this.  However, it can take several weeks to several months to fully recover.  Early activity in the distribution of the nerve is a good sign.  I would not be in a rush to have BOTOX placed.  I think seeing the nerve recover will be important for reassurance.  Nerve injuries that have not recovered by 6 months are unlikely to improve.


Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

BROW PROBLEMS AFTER FACELIFTING SURGERY

+1

Temporary immobility of the facial muscles can occur after facelifting surgery.  This is certainly a frontal branch paresis of the facial nerve.  At 4 days postop, I would not panic.  This is seen periodically.  Sometimes swelling or bruising of the nerve can produce this.  I would wait several months prior to intervening with a procedure such as a unilateral brow lift. I also would be in no rush to have botox injected.  Give it time!

Jeffrey B. Wise, MD, FACS
Wayne Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Eyebrow Droops After Mini-lift. Doc Suggesting Botox?

+1

It is very unlikely that your right brow will be permanently weakened.Usually the nerve is stretched or otherwise temporarily stunned. This should come back and patience will serve you very well. With regard to Botox, treating the right side would have minimal impact (slight elevation of the outer part of the brow) and would not cause the movement to return any faster. However, treatment of the left side would decrease its function and provide you with better symmetry while the right side recovers. The bottom line is that your brow function is likely to completely normalize. I'm glad you're otherwise happy with your surgeon's work!

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

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Usually the weak nerve is just bruised and not cut.  This usually improves in the next several weeks to months.  If permanent, brow lifting or Botox on the opposite side could help.

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Drooping brow after facelift

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More than likely the function will return after 2 weeks to 6 months. In the meantime, Botox can be used not to lift the drooping brow, but to paralyze the the working brow so they will match. If in the long run, there is no return of movement, continued use of Botox might be warranted or a unilateral brow lift might help. Many years ago, I treated a patient who had a drooping brow from an old Bell's palsy by lifting both brows and deliberately cutting the nerve to the good brow. The result was very good for not only symmetry but  also for a rejuvenating appearance.

There is no need to be frightened with these possible therapies available.

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Eyebrow Droop: Can Botox or Dysport fix a drooping eyebrow?

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There are many different causes of a drooping eyebrow. If an eyebrow droop is acute (i.e. new or came on relatively suddenly), here are some of the possible causes:

  1. Bell's Palsy--one side of the face becomes partially paralyzed
  2. Post-surgical injury: Immediately after surgery, one can experience paralysis of muscles from the anesthesia. This often lasts for up to 6 hours and resolves completely within 24 hours. Additionally, post-surgical swelling can cause heaviness of an eyebrow, that usually is not very pronounced, but may take 1-2 weeks to resolve. Injury to the nerve itself is possible, which is often temporary taking weeks or months to recover, although can be permanent.
  3. Trauma--An injury to a facial nerve can cause drooping that may resolve within weeks or months, although can be permanent

In this case, where drooping occurs after a surgical procedure, one must consider the likely causes listed above in #2 which should be addressed with the surgeon immediately so that an accurate assessment of the cause is made.

Botox and Dysport are used to paralyze muscles. They are not used to improve muscle function. When indicated, how do I handle a drooping eyebrow with Botox or Dysport?

  • They can be used to cause a slight elevation of a drooping eyebrow
  • They can be used to slightly paralyze the other forehead to lower the other eyebrow to make things look more even

One must remember that the effects from Dysport or Botox are temporary, lasting 3 months or slightly longer and treatments must be continued to enjoy the benefits from this treatment.

Robert S. Bader, MD
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Eyebrow Droops After Mini-lift. Doc Suggesting Botox?

+1

Thanks for the posted photos but it is way early to advise. If the swelling decreases than you still have poor right lateral eyebrow issues than I would try BOTOX or a lift of the area. But again very early in healing phase. 

Darryl J. Blinski, MD
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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.