Asymmetry After Endoscopic Forehead Lift

Question

I had an endoscopic forehead lift about 5 years ago. It was done by a highly experienced and reputable plastic surgeon. Immediately after surgery, I noticed asymmetry. The doctor advised patience and told me it would settle in with time. I was also not eager for more surgical procedures and figured in time I would get used to it.It has been five years and it is bothering me more now than before. One eyebrow is noticeably higher than the other and it affects the shape of the eye. One eye is round, the other is oval. I would rather not go through life looking deformed. Can anything be done about this. I like the lower brow side much better. Can the brow on the other side be lowered? What are my options? Do I have any options? Thank you.

Lawrence Kass, MD · Answer

It is always difficult to answer these kind of questions without seeing photos. But I do agree that often an overcorrected brow can be brought down to improve symmetry without undergoing all of the trauma and swelling of the original procedure. good luck!

Stephen Prendiville, MD · Answer

Unfortunately, at 5 years after a browlift, the asymmetry present is permanent. However, several factors must be considered including the fact that most patients have some degree of brow asymmetry before a browlift which may or may not be corrected with the procedure. Failure of the fixation device and/or inadequate brow release on one side are other possibilities at the time of the procedure. Nonsurgical options for lowering the "higher" side include Botox. If you are considering revision surgery, greater control is likely to be achieved with an open or Trichophytic procedure in which the lower side could be raised preferentially. My general recommendation to patients who have had an issue or failure with the endoscopic procedure is to consider a Trichophytic lift (incision along the hairline, following the natural progression and recession of hair follicles).

Anil R. Shah, MD · Answer

There are many causes of asymmetry of a browlift:

	
		Pre-existing asymmetry of brow unrecognized
	
		Asymmetric lifting of brow
	
		Asymmetric removal or weakening of muscles


	 

	Fixing an asymmetric brow can be done with either botox or possibly a revision procedure.

Vincent N. Zubowicz, MD · Answer

When a browlift is overdone, it can be reversed but only with another operation. Furthermore, the description of the aperture of the eyes would presumably be related to something other than browlift such as eyelid surgery. You might want to try botox on the side of the forehead that is too hight to see if paralyzing the frontalis muscle on that side is the cause. It would help deciding what operative approach to take.

Houtan Chaboki, MD · Answer

Mary11,
You have options. Botox is a great option to help adjust brow height a little bit, to produce a more symmetric eyebrow. It is better at lowering a brow, than elevating. Results with Botox may vary.
Revision endoscopic facial surgery is the next option. Brow asymmetry may be treated by another endoscopic approach, or alternatively a traditional open approach. Most surgeons perform endoscopic brow lifts currently, but brow position is better controlled with an open or direct approach.
Lastly, everyone has some degree of asymmetry to the face, especially the eyes and eyebrows. Facial asymmetry is natural. Some degree of asymmetry may have been present before surgery.
Speak with a plastic surgeon in-person to be able to determine what treatment approach would be appropriate in your case.

Karol A. Gutowski, MD, FACS · Answer

I don't know if there is much you can do about the oval vs round eye as it may be unrelated to the brow lift. Botox can raise or lower an eyebrow a little bit. It is hard to lower an eyebrow surgically but raising an eyebrow can be done. Since you had this problem right after surgery, it may be worthwhile to ask your original surgeon about a revision.

Pat Pazmino, MD, FACS · Answer

After an endoscopic forehead lift, there is a risk of asymmetry. If this has there are many different options to correct this. If it is a small amount of asymmetry is possible to practice with any direct temporal brow lift on the lower side. This will help elevate this brow and create asymmetric appearance. This may be performed under either local anesthesia or as an outpatient procedure.

Sam P. Most, MD · Answer

Asymmetry after a browlift (of any type) may be treatable. Key to determining if and how it can be treated would be examining the degree of asymmetry (in mm), the nature of the asymmetry (is it dynamic or static--that is, is it constant or does it vary?), and your facial features (wrinkles in the forehead and hairline position). The fix may be relatively simple (such as Botox) or a minor procedure (done under local anesthetic). Hopefully, your surgeon can help guide you through this process.

Jonathan Hoenig, MD · Answer

For a permanent option, it is possible (though not easy) to surgically lower your higher brow. For a temporary fix, botox injection into the forehead above the higher brow will give you about 3 months of correction.
Regarding the eye shape, most people prefer the oval or almond shape and it should be possible to achieve reasonable symmetry. My suggestion is go to someone who specializes in eyelid surgery such as an oculoplastic surgeon. You can find one near you at www.asoprs.org or email me photos at info@drhoenig.com for a preliminary opinion. About half of my practice is now comprised of revisions of prior plastic surgery.

Brian K. Brzowski, MD, FACS · Answer

If you think having the higher side lowered would look good, give Botox a try. 
There aren't too many good permanent options that will lower the eyebrow otherwise.  Raising the lower side is however an option.
Good luck!

Asymmetry After Endoscopic Forehead Lift

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