Neuropraxia of Frontalis Nerve Questions

Question

After brow lift, both brows had paresis for 3 months, but one brow raised and one still 1" lower after 4.5 mo. Did surgeon know he did this? Why would he not tell me? Have you heard of function returning later? Who is best US neurologist to help? Best PT for this? I will go anywhere! Any exercises,etc. when brow is paralyzed? Where to get electromyography and nerve excitability tests? Any hope is appreciated!

Richard H. Tholen, MD, FACS · Answer

The frontal branch of the facial nerve is a motor nerve that controls contraction of the frontalis muscle which raises your eyebrows. This branch can be injured during browlift surgery, and since this is such a tiny and minimally visible fiber, even experienced surgeons can unintentionally damage this nerve in the course of browlift or forehead lift surgery. If the nerve is bruised, stretched, or just inflamed, it will heal. This can take days to months. If the nerve is inadvertently cut, the brow paralysis on that side is permanent. An EMG (prescribed by a neurologist) can identify nerves that are damaged vs. severed. Surgical repair, if done early enough by an expert in microsurgical nerve repair, can maximize functional return. If delayed too long, permanent loss of frontalis function (elevation of the brow) may result.

	You should see a neurologist at this point for evaluation and EMG. The results of that test will dictate further recommendations. In the meantime, there is nothing else to do. I am sorry that you have had this problem; it could happen to any of our patients despite our best efforts, intentions, and skill. Good luck!

Lawrence Kass, MD · Answer

Fortunately, this complication occurs only uncommonly after browlift surgery.  When it does happen, it usually resolves in 12-18 months.  Yopu can have all kinds of neurologic simulation tests, do lots of exercises, and expressed a willingness to see any neurologist to help you resolve this problem.  But I agree that seeing a local neurologist for nerve conduction studies and EMG would likely reassure you that full recovery may still occur and save you from unnecessary expense.

Steven L. Ringler, MD, FACS · Answer

Sorry to hear about your concerns following your brow lift.  The frontal branch of the facial nerve is susceptible to injury during a brow lift.  Though uncommon, this may not be apparent to the surgeon until after the surgery. If the nerve is injured but not severed, then recovery can take anywhere from 6 weeks to 18 months.  If the nerve has actually been severed, then surgical repair would be necessary for nerve recovery.  You should discuss your concerns with your plastic surgeon and request a referral to a neurologist for evaluation.  EMG's and nerve conduction studies would likely disclose the extent of the underlying nerve injury.  Good luck to you.

Joseph A. Eviatar, MD, FACS · Answer

A brow lift can cause either temporary or permanent brow paralysis.  Generally this resolves but you should go to your doctor if it does not to see what can be done.  It is unclear if any kind of exercise will actually improve the situation.

Neuropraxia of Frontalis Nerve Questions

Answers (4)

Answer: A brow lift can cause either temporary or permanent brow paralysis

Answer: A brow lift can cause either temporary or permanent brow paralysis

Recommended reading

Everything you need to know about Brow Lift

Our mission is to create a world where every investment in modern beauty is Worth It.

Neuropraxia of Frontalis Nerve Questions

Answers (4)

Answer: A brow lift can cause either temporary or permanent brow paralysis

Answer: A brow lift can cause either temporary or permanent brow paralysis

Browse related questions

Recommended reading

Everything you need to know about Brow Lift

Our mission is to create a world where every investment in modern beauty is Worth It.