Can an endoscopic brow lift gone wrong be treated with Botox after surgery for temporary improvement? (Photo)

Question

I had an endoscopic brow lift 9 days ago. When I woke up I immediately saw my eyebrows were not symmetrical. I questioned the nurse but she said I was swollen to give it time. The next day I saw my doctor and he confirmed that I was swollen that with time It should get into place. As you can see it has gotten worse not better and my one eyebrow is lowering by the day. I read that I need to wait 6 months before going through another endoscopic surgery. Any suggestions will be truly appreciated.

Peter Lee, MD, FACS · Answer

The most important thing to establish is whether you have normal movement of the the frontalis muscle on the lower, i.e., right, side of the brow. If you do not, there may have been some injury to the frontalis branch of the facial nerve. Most likely the nature of this injury is a neurapraxia, most commonly due to pulling and stretching or compression of the nerve branch.  If such an injury is suspected, this could be confirmed by nerve conduction studies.  Most commonly, even if such an injury has occurred, the nerve will return to function after several months. In the interim, the higher brow could be dropped to a level more symmetric with the lower one through judicious injection of botox, while you wait for nerve function to return on the right side.  If muscle movement of the frontalis appears normal on the lower side, then a revision procedure may be in order. You did not mention what kind of fixation was used. If endotine fixation was used, the endotine on the right side may be adjusted fairly quickly and this may resolve the issue.  If a formal revision surgery is required, you would be well advised to wait three to six months before embarking on such a procedure.

Ross A. Clevens, MD, FACS · Answer

It seems that you are very nervous about your browlift recovery. I suggest you remain patient - time will heal your eyebrows and allow the results to take shape. Only once you are fully healed should you consider Botox or any other follow-up treatments for that matter. I suggest you consult your board certified facial plastic surgeon so that he can monitor your progress and be a soundboard for your concerns.

Vartan Mardirossian, MD · Answer

There has been a long lasting debate on which browlift technique is the best. There are certainly alternatives to the endoscopic browlift with cosmetic incisions and predictable results. I encourage you to look into the subcutaneous technique as that one allows a precise elevation of your eyebrows. There are others,  too but I feel that that one will serve you best with the problem you are presenting. Two months is what I would wait before revision. Yes, botox may help in the interim. Hope this helps and best of luck!

Patrick Flaharty, MD FAACS · Answer

Asymmetry of the eyebrows after an endoscopic brow lift is not uncommon.  Botox can be used for temporary improvement while the brows are healing.  Re-operation should always be delayed for 6 months to insure the tissues have healed completely.  Sometimes a touch   up minilift can be done on one side only to improve the asymmetry.  This minilfit can often be completed in the office without anesthesia and much less downtime.  In cases where a more complete revision is required would entail a trip to the operating room like your intial procedure.

Gregory D. Lewen, MD, FACS · Answer

The important question here is whether you still have normal movement of the frontalis muscle in your forehead on the right side or if it appears to be weaker than that of the other side.  If there is some weakness of the muscle present, it is usually due to some temporary nerve dysfunction that can occur immediately after having an endoscopic brow lift.  It is also entirely possible that you still have some normal post-operative swelling that still needs to subside.  I would be cautious about having an additional procedure performed this soon after your initial surgery.  Generally, the best practice is to give your body the time it needs to appropriately heal for at least 3-6 months before considering additional surgery.  You don't want your surgeon trying to hit a moving target.  In the meantime, Botox injections may be a reasonable solution to improve any asymmetry that is present.  Best, Dr. Gregory Lewen

Eugene L. Alford, MD · Answer

Yes I see that your brows are not even. The first thing to determine is if your forehead moves the same on both sides. The lower brow could be down because of an injury to the nerve that moves the forehead on that side. If that is the case the two sides may even out as the nerve recovers. If an endoscopic brow lift was done and a  carpet tack device (Endotine) was used to hold the scalp up,  then the low side can easily be lifted to match. Other than that, tincture of time to see if the low brow is from swelling is all you can do. After 3 months if the brows are still uneven a revision will be necessary

Darryl J. Blinski, MD · Answer

Sorry for your experience. I would offer Silhouette Lift to correct the asymmetry. Fee range from $1,000, with immediate results.

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