Paralyzed eyebrow and forehead 6 months post-op. What do I do? (Photo)

Question

Hello. I am an active man aged 44 with good healthy and usually recover well and fast. I had a facelift and brow bone shredding. One brow has movement coming and a few lines showing on the forehead. But after 6 months the other side is still totally paralyzed. I have no significant swelling. My forehead has no wrinkles which i am guessing that i still have more recovery to wait for . But after 6 months i am starting to suspect that the surgeon ( Turkish) must have cut a nerve or something.

Cory Bovenzi, MD · Answer

Hi, thanks for your question. Yes, it does appear that the left side of your forehead does not have proper innervation. The frontal branch of the facial nerve is at risk with facial surgery, especially surgery of the brow and temple where the nerve runs. At 6 months I would expect at least a small amount of movement if the frontal branch was still intact. At 12 months is the definitive time to see if any movement returns. If the asymmetry bothers you, one possible option is to inject the strong right side of your forehead with botox so they are even as you await the final result at 12 months. However, as you know, losing nerve control of forehead muscles does make your eyebrow lower. If the damage is found to be permanent, there are ways to elevate the brow with browlift techniques so they are more symmetric, but bringing innervation back to a forehead with the frontal branch damaged is very difficult.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. The lack of wrinkles above your left brow and not having movement in that area are most likely indications of a form of nerve damage. You may wait a full year to see if movement will return (though you might still be in the healing process). You may also consider procedures like Botox to achieve temporary facial symmetry if you are bothered by its appearance. 
Consider seeing a neurologist to check for nerve damage, then consult with a reputable board-certified facial plastic surgeon to explore your options for further procedures. I recommend only seeking cosmetic treatments from reputable board-certified facial plastic surgeons. These experts have a thorough knowledge of facial anatomy and will have the skills and training to safely perform the most advanced techniques and help you achieve your desired goals.

Michael A. Burnstine, MD · Answer

Your photograph was helpful. The lack of brow movement and lack of wrinkles indicate that the superior branch of the facial nerve (7th cranial nerve) has been affected. Botox on the right side may create symmetry. Alternatively, a unilateral brow lift will raise the eyebrow and give more upper eyelid show. Unfortunately, brow movement will still be absent most likely.

Brian K. Machida, MD, FACS · Answer

Sometimes recovery of a nerve can take longer. I’ve noted that some of my colleagues had patients who took longer than 6 months to recover. It’s best to wait a full year. Nerves can be injured in various ways other than being cut: they can be stretched, shocked, sustain thermal injury. In the last case, bleeding blood vessels can be closely associated with nerves and cauterization can cause thermal injury. Best of luck in your recovery.

Ronald J. Edelson, MD · Answer

The nerve may be damaged or just bruised. It might come back with time but in the meantime Botox can be used on the non paralyzed side to give you symmetry. The other option if it remains paralyzed is to cut the same nerve in the other side. At least then you will be symmetrical

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