One Brow Not Moving 1 Month After Brow Lift

Weakness of the forehead or eyebrow is a rare but one of the most dreaded complications of brow lift surgery. This can be due to a temporary weakness in the form of a bruise or stretch on the nerve or less likely a permanent damage . While fortunately the former is the case in majority of the times, such recoveries can be painfully slow and it can take months for the muscles to return to full or near full strength. As such, keeping close communications with the surgeon and following the instructions is key for allowing the proper healing of the tissue to occur and avoiding any premature or potentially harmful revisions.

I suggest you follow your surgeon’s advice and give it a bit more time - maybe up to 6 months or so, during which time movement will gradually return. The muscle or nerve responsible for movement of your one brow may have been affected during surgery, however it usually corrects itself as you recover.

What you have described can be expected after a brow lift.  I recommend keeping in close contact with your surgeon or his/her clinical team to address your concerns.

Brow lift surgery can have a dramatic impact on facial aesthetics, but there is also the potential to have complications with this type of surgery. There are several different types of brow lift that can be used to address brow descent. One thing that they all have in common is the potential to damage the frontal branch of the facial nerve.
This nerve is responsible for elevating the eyebrow. During surgery, the nerve can be divided or damaged, and when this happens, eyebrow elevation is no longer possible. This may be a permanent problem. More commonly the nerve is stretched. When this occurs, the paralysis is transient and function usually returns with time.
You’re still early in the post-operative course, and there’s a good chance that this will improve with time. Be patient, your surgeon’s assessment is probably correct.

When doing a brow lift you get very close to a nerve branch of the Facial Nerve (frontal branch- the branch that raises the eyebrow)  that runs near the outside edge of the brow.  Unfortunately, there is a blood vessel that runs very close to the nerve branch.  When cauterizing the blood vessel, that nerve is at risk of both temporary or even permanent damage.  At one month you are still way to early to see nerve function return if the loss is temporary.  It usually takes 3-6 months to come back.  Permanent nerve injuries are relatively rare (I've never seen one in my practice knock-knock), so be patient and it will probably return.   

The "power cable" to the brow is the frontal branch of the facial nerve and it is potentially at risk for injury during a brow lift.  Most injuries are related to traction and temporary with function returning from 6 weeks to 6 months.  The best advice I can give you is have a frank discussion and close follow up with your Surgeon.  The asymmetry in motion can be countered with Botox until the affected side begins moving again.

This type of injury will typically correct itself over 3-6 months.  If the asymmetry is a big concern in the meantime Botox can be used to improve this.

This can be caused by mechanical intereference with the muscle or nerve.
You did not specify the type of procedure
Generally recovery of nerve function is to be expected in most cases of brow lift but it depends on the technique

Transblepharoplasty brow lift (through the eyelid)
Direct brow lift (excising skin above the eyebrow)
Pretrichal Brow/Forehead Lift (in front of the hairline)
Endobrow lift (Forhead lift using endoscopic techniques )
Coronal brow lift (incision across the scalp from ear to ear)
Contour thread or suture suspension (thread style lift)

Depeding on what technique was used the nerve or muscles can be exposed to differing amounts of injury and will recover over different time periods.

Temporary weakness of the forehead muscles after a browlift is not uncommon. There are several possible causes. The nerve that causes movement of the brow runs very close to a vein that frequently needs to be cauterized. This can cause some heat transfer to the nerve that may prevent it from working properly.
Also, the surgery itself can cause a direct injury to the nerve by stretching it. These types of injuries typically heal within 2-3 months and complete recovery of the movement is expected. Rarely, the nerve can be cut. This is extremely rare, but if it does occur, recovery could take 6 or more months and may not be complete, leaving that brow weaker than the other.
In the vast majority of cases, however, the brow movement returns completely, so be patient.

inability to lift one eyebrow after either an endoscopic or open forehead lift or brow lift is not uncommon. it is usually due to post-op swelling, stretching, or bruising around the frontal branch of the facial nerve. In most patients the funciton of the frontalis muscle which lifts the brow recovers from two to 9 months. Meanwhile, if this bothers the patient, they can weaken the other side with botox to achieve more symmetry.
Sean Younai, MD, FACS