Sudden Eyebrow Paralysis After Face Lift and an Upper Blepharoplasty - 1 Month Post-op.

Question

I had a face lift and upper blepharoplasty at the same time and everything went very well - no bruising, I am healing well and very happy with the result so far. However, suddenly after 1 month, one of my eyebrows has lost all movement and is slightly lower than before. There is some sagging of the upper eyelid as well. I am very worried but my doctor believes that this will heal on its own. Why did this happen all of a sudden?

Kenneth D. Steinsapir, MD · Answer

Maria

	It is certainly possible that this did suddenly develop one month after your facelift and eyelid surgery.  This would be very unusual.  If this is actually correct, then I would be concerned that this might be a form of Bell's palsy.  There are some other potential causes.  However, they are all pretty unusual.  Another possibility is that you had an injury to the right temporal branch of the facial nerve at the time of surgery and it was not noticed until now.  This might seem shocking but a lot of thing are going one as you heal from this type of surgery.  Before you dismiss this possibility please know that this is most likely situation.  What do I recommend at this point, you and your surgeon should closely follow this.  I know that this will also sound a bit strange but unless your surgeon examined you very carefully, you may have had this weakness before surgery.  However, if you were not examined for this, of course your surgeon is still responsible for the weakness (because it was not documented).  I would say the most likely possibility is motor nerve injury at the time of surgery.  Will this recover?  Many of these injuries do recover but it can take months and there may be residual weakness.  On the other hand, if your facial weakness seems to be getting worse and spreads to the lower half of the face, this will warrant a more complete neurological work up.

Stephen Prendiville, MD · Answer

Loss of motion in the forehead 1 month after a Facelift is very unusual. If the entire hemiface was involved it could be attributable to a viral etiology as in Bell's palsy. Although the frontal branch of the facial nerve is theoretically at risk during a Facelift, sudden loss of motion in the forehead 1 month after surgery is hard to explain. However, your Surgeon is correct that motion is likely to return. If you were my patient, I would probably place you on steroids and antivirals to cover all of the bases.

Raj S. Ambay, MD · Answer

Given the timing and description of your symptoms, I would favor that you sit tight. Nerve function will come back but it will just take some time. In the interim, make sure you keep your plastic surgeon in the loop. Good luck things will get better.

Robert Brueck, MD · Answer

I would sit tight.This should go away in time.Time could be several months so relax.i guess he could do botox on the other side to equalize it.

Darryl J. Blinski, MD · Answer

Thanks for the posted photos. It is quite obvious your VII faciaL NERVE FRONTAL BRANCH on your right side has paralysis. 

	Causes are: 1. Surgical injury, 2. Un noticed weakness prior to surgery, 3. Post op Bell's Palsy. 

	Best to be seen immediately.

Steven Schuster, MD, FACS · Answer

Dear Maria, my major concern would be a Bells Pa;lsy if this occurred only on one side. It might be worth seeing a neurologist as well as discussing your concerns with your plastic surgeon. Since this occurred one month out and until then all was fine, I would doubt it was related to the surgery. I am sure this will resolve.

Edwin Ishoo, MD · Answer

It would be highly unusual for this delayed paresis or paralysis of the forehead muscles or the frontal branch of the facial nerve to be directly attributable to the facelift or upper bleph procedure you had one month prior. There may be scar bands that are compressing the nerve but I would be more concerned with a process or pathology affecting the upper branch of facial nerve since the rest of the face is moving properly and you describe no change in sensation of the face or visual acuity. A partial Bells palsy is possible but Bells Palsy is a diagnosis of exclusion and should never be thought of as a primary diagnosis. I would highly suggest a consultation with a neurologist and likely an MRI of head with contrast to specifically rule out central, skull base, parotid or peripheral pathology as soon as possible before starting any steroids or antivirals. If you are having any difficulty closing the right eye completely, please see an ophthalmologist and start on artificial tears to protect the eye from conjuctivitis sicca and corneal abrasion.

David A. Bray, Sr., MD · Answer

I think the most likely explanation is that the weakness of the brow went unnoticed at first. Other causes could explain this. You may need to see a neurologist

Francis (Frank) William Rieger, MD (retired) · Answer

Maria, there are  several causes for an isolated nerve injury, but the time of the noted finding may be very important in making a decision about this.  If this was a consistent finding directly following surgery and has persisted, one may  need to think about a temporal nerve injury.  This could be a direct result of a  surgical nerve injury, but this does not mean that it is permanent.  It could be from localized swelling or inflammation, and may very well get better when the swelling improves in several months.  Another possibility would be a nerve injury from a Bell's Palsy, which oftentimes improves with treatment with antiviral and steroid medications.  Best to discuss this with your Plastic Surgeon and possibly a Neurologist.

	 

	Good luck to you.

Francis R. Palmer, III, MD (retired) · Answer

I have performed Face Lifts for over 20 years and your photo shows paralysis of the temporal branch of the facial nerve on the right side. The question is was this evident immediately after the Face Lift? It you were able to move your eyebrows and forehead, on the right side up until 1 month after the surgery, the Face Lift and Eyelid Surgery are unrelated, IMHO.

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