Hemifacial spasm after endoscopic brow lift

Question

About six months after my endoscopic brow lift, I started having hemifacial spasms. It has now been eight months and they seem to be getting worse, not better. They appear when I am tired, under stress, eating, or speaking. My surgeon says that healing of the nerves after a brow lift can take over a year. Is this true? Should I get Botox to help alleviate the symptoms or will this just delay the healing process?

Alejandro Nogueira, MD · Answer

Your problem is uncommon and makes no sense after a forehead lift, either endoscopic or open approach. Obviously the postoperative swelling should be the trigger to the spasm, but not the underlying cause, which for sure was present preoperatively in an undetectable form. I would make a deep health and neurological test, including all the analysis to explore the usual causes of muscular facial spasm.The most likely scenario is a total normalization when swelling disappears (12 to 18 months), and for sure I am convinced your surgeon did not "touch" wrong wires there inside.The logical scenario is a postoperative swelling triggering a previously undiagnosed neurological condition.

Sam Goldberger, MD · Answer

Hemifacial Spasm is a true condition that originates in the brain.  Therefore, if you have true Hemifacial Spasm, then either this is a strange coincidence after the brow lift or it is an extremely rare complication that has no real understandable connection to the surgery (which sometimes occurs in medicine).  However, you might not have true Hemifacial Spasm.  You might have nerve damage with aberrant regeneration that mimics hemifacial spasm.  I see this mostly with people who have developed Bell's Palsy which causes a paralysis of one side of the face and then the nerves regenerate incorrectly and cause spasm.  The first thing yoiu should do is to get a true diagnosis from an experienced Physician who treats Hemifacial Spasm (Oculoplastic Surgeons do this).  Next, a plan of treatment can be mapped out for you.

Pierre Guibor, MD · Answer

Follow  your doctors advice and try some tincture of time. I have seen this type of spasm and it takes about 1 year for evaluation.

Michael Elam, MD (retired) · Answer

Dear fatherland, I perform a lot of endoscopic brow lift procedures and this is a very uncommon complication of this procedure. You may have some cross innervation of a nerve which means that the nerve is triggering a different muscle then it is designed to. I would speak with your surgeon regarding what treatment he/she feels will benefit your recovery. Best regards, Michael V. Elam, M.D.

Hemifacial spasm after endoscopic brow lift

Answers (4)