What Surgery is Best to Restore Paralyzed Inner Frontalis Muscle Now 18 Months After Coronal Brow Lift?

At 18 mo, left eyebrow is 1" lower than right eyebrow! Surgeon used Botox on right eye & on "drooping" left eye, but doesn't last. At 1 year, the outer frontalis muscle elevated, but inner frontalis still does not. Doctor said this nerve is one & will eventually work. I have doubts. Hate "heaviness" in eyebrow.Would brow-life in hairline, direct incision above brow, or Pretrichial lift be best? Is this a more difficult repair than original coronal lift? Bascom-Palmer is closest eye & Univ hospital.

Doctor Answers 7

Direct, Coronal, Pretrichial, Internal Brow Pexy for Brow Paralysis

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    At 18 months, you may want to wait until 2 years before surgery.  There is very little chance after 2 years that you would recover function.  All of these approaches are possible depending upon a number of variables.  Direct browlift may be reasonable if you still have very deep wrinkles.  Brow pexy may be possible through upper lid, but it cannot usually get an inch of lift.  Incision through the original scar and lift with bony anchor focusing on the medial brow may be an option.  Pretrichial may be appropriate depending upon the length of incision used and the space between the coronal incision, without worrying about necrosis.  See a board certified plastic surgeon who does all of these approaches, so that the best solution can be offered and not just the one that a particular surgeon does.

Restoring Brows

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Though there is still chance that you will regain movement in your brow, it sounds like undergoing another surgery will benefit you most. I suggest visiting an experienced facial plastic surgeon wil experience in treating facial paralysis as well.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Frontalis paralysis

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I second Dr Toby Mayer's comments below. Surgical elevation of the brow using one of several techniques is needed.The irregular trichophytic approach is excellent.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

Trans-Blepharoplasty Brow lift is an option

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Another option to treat your lower eyebrow on the left is a Trans-bleph brow lift which is done through an upper eyelid incision and lifts the eyebrow selectively. A disolvable implant called an endotine is used to hold the eyebrow up while it heals in a more youthful position. I have been performing this for over 5 years and I use it for both cosmetic patients and people who have had brain tumors where one side is paralyzed and it works very well. Like all techniques it has limits as to how much it can raise the brow but that would have to be evaluated in person. Best wishes, Thanks

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Brow ptosis (droopiness) after surgery

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Paralytic brow ptosis (brow droopiness) can happen after surgeries, Bells palsy, etc.  The recovery period is about one year, after which, no further significant change is expected.  There are various brow lift options in paralytic brow ptosis, and the best option may be different for each person. Factors to consider are sex, age, forehead hairline position, etc.  See an oculoplastic or facial plastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Be careful

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If you've already have had a coronal browlift, you should be very cautious with proceding with a trichophytic [hairline] browlift as the island of tissue between the two incisions could have lessened bloodflow and be at risk for skin necrosis. I have seen such a result before.

This may not happen, but it would be a risk that I would not take.

Please post a photo so that we can get a better appreciation of the asymmetry.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Forehead paralysis after forehead lift-18 months.

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Forehead paralysis after forehead lift-18 months is unlikely to return. The medial brow can be elevated with the Irregular Trichophytic Forehead Lift where the hair grows THRU the scar and in front of it . We developed that operation 30 years ago and it is still the best for most situations.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.