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Need help--paralyzed left eyebrow after mini-lift!

Need help--paralyzed left eyebrow after mini-lift!

Postby marilynn25 » Tue Nov 13, 2007 3:32 pm

Hi! I just had a mini-facelift today, along with a rhinoplasty, and I feel really, really good, all things considered! :) But I discovered that I can't move my left eyebrow anymore, or the left half of my forehead! I CAN move my right eyebrow and eyelid and right half of my forehead just fine. I didn't have anything done to the upper half or the middle area of my face, other than my rhino. It feels like I've been Botoxed in my left eyebrow area. Is this some kind of paralysis??? Is this going to be permanent? :( Has anyone else ever had this weird thing happen?? Now I'm getting nervous!!! All answers welcome!!
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Postby marilynn25 » Tue Nov 13, 2007 3:34 pm

Oh, yeah--I almost forgot: I CAN move my left eyelid just fine and my left cheek. It's just what's above the left eye that won't move anymore!
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Postby DCNGA » Tue Nov 13, 2007 6:06 pm

You might want to post your question to Dr. Naderi on this board. He answers pretty quickly and with understandable responses.

Good luck.

D
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Left forehead paralysis

Postby MillenniumFPS » Tue Nov 13, 2007 8:56 pm

marilynn25,

Most likely this is a temporary paralysis from the local anesthesia used during your mini-facelift procedure. Give it 24 hours, and most likely you should be able to move your forehead again. If not, you should contact your plastic surgeon to inform him/her that about the forehead paralysis.

Here is an example of how it looks (for the MMH forum.) It's the right side on this gentleman. It does look and feel like Botox, but only on the one side.
Image
Image Credit: http://www.dragndrop.de/

The most common cause of this type of paralysis immediately after a facelift is from the local anesthesia used to inject the skin prior to the facelift. The local anesthesia blocks nerve impulses on sensory nerves (nerves that give you feeling); however, if the local anesthesia is injected close to the temporal branch of the facial nerve (which controls movement to the forehead muscles and frown muscles, see the diagram below) it can cause a similar effect as Botox. Eventually it will wear off. There are two types of local anesthetic that surgeons may used for facelifts, xylocaine which wears off in about 3-4 hours and another which is longer acting which can take more than 9 hours to wear off. Some surgeons will use the latter to make the first night after surgery more tolerable.

Image
Image Credit: http://www.med.yale.edu/caim/cnerves/cn7/cn7_6.html

If it does not come back in 24 hours, the second most common reason for this weakness or paralysis of the forehead is from using the heat or electrical energy, that we use to seal off blood vessels, this is called cautery. If this is the case, the nerve is intact and there is a slight injury to the nerve due to the heat or electricity, and this can take from a few weeks to a few months to come back. The good news is that it is like having botox to your forehead and frown lines. Most surgeons feel bad about this and will offer you botox to the other side of your forehead and frown lines to prevent assymetry, and as the Botox wears off over a 3-4 month period, usually the "paralyzed" side will come back in this similar time period.

The last possibiility, which is very rare, especially for the experienced facelift surgeon is that the nerve was cut. I wouldn't worry about that possibility at this time.

You might ask yourself, if injurying the nerve works like botox, why not injure it on purpose during the facelift in order to get a botox-like effect for several months. This is the basis for a new technology called GFX. http://www.acisurgery.com/ . The reason that plastic surgeons don't do this on purpose is that it is "poor form" to have a facial paralysis and we are taught how not to get facial nerve injuries. However, with the GFX technology, the goal is to find the nerve as it travels to the frown lines or forehead and selectively injure the nerve with radiofrequency energy, to take a small segment of the nerve out. The manufacturer is currently doing studies to determine how long this paralysis will last. If this works well, it will be a good alternative to Botox in the future. I will keep the forum posted as new information comes up about this technology.

In the meantime, I will keep my fingers crossed for you. Most likely the movement will come back soon. But if it doesn't, you can look forward to some free Botox to smooth your forehead and frown lines. Either way, this should help you to sleep tonight.

Keep us posted with your progress.

Best,

Dr. Yang

www.GeorgeYangMD.com
www.Twitter.com/GeorgeYangMD
www.Facebook.com/GeorgeYangMD
Google+

My online posts are not a substitute for a physician evaluation and examination and should not be considered as medical advice.

Private inquiries: info@nycface.com
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Postby Elaine » Tue Nov 13, 2007 10:25 pm

...... or if it is nerve damage, as I had, nerves can and do regenerate. Be glad it's your forehead, some of us walked around talking like Elmer Fudd for 6 months!
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Postby Annie2007 » Tue Nov 13, 2007 11:42 pm

Dear Marilynn25,

First, I hope this finds you already back in control of those muscles and on your way to a smother recovery with great results.

I recently had some similar temporary paralysis after local anesthesia was injected into one side of my face for a small hair transplant (to cover a missing temporal portion of hair). During the procedure I realized I could not raise my one eyebrow nor could I move that half of my forehead... a total surprise and very scary. The young doctor even appeared surprised, saying he had never seen it happen before, but assured me it would soon wear off. The anesthesia, injected in close proximity to the facial nerve, had migrated up the branch which feeds the eyebrow/forehead.

All turned out fine. It was at 3 AM that night when my movement did return (roughly 10 hours after the injection), with immeasurable relief. I hope your get the same relief very soon, if you haven't already.

Annie

ps. I still would call your ps if you haven't already, to apprise him of this.
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Postby marilynn25 » Wed Nov 14, 2007 9:01 am

Thanks to everyone for your answers! I am actually starting to get a little movement back in my left eyebrow now, so I guess what Dr. Yang said was true. What a relief! I did panic. It was very, very scary not being able to move my eyebrow, especially since, 13 years ago, I had damage done to my right eye's nerves and muscles after taking a fall down the stairs in my house and cutting the outside corner of my eye, fracturing my right orbit bone and knocking down my cheekbone a little. I have had five operations on it since then to correct eyelids that don't work quite right, and the upper eyelid still does not stay closed at night. So, I was afraid that this left eyebrow paralysis was going to be permanent. Anyway, I am so grateful for all your replies and help. I will let you know when the movement comes back. Take care, everyone!

--Marilynn
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Postby marilynn25 » Thu Nov 15, 2007 6:14 pm

Okay; all my eyebrow's movement was back as of yesterday (Wednesday). So I guess it was just a freak side effect of the injection being too close to that nerve bundle. Thanks for everyone's help. Now I can look forward to healing up completely and getting my stitches out without worrying about anything other than looking like a chipmunk with the mumps!
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Same Problem Right Eyebrow & Forehead

Postby Trisha10 » Thu Nov 15, 2007 11:16 pm

Hi,

Just wanted to give you some hope from my personal experience. After my facelift I could not raise my right eyebrow or lift my forehead on that side.

After waiting a month (per my doc's suggestion) for some return, he did another operation to directly ennervate the temporal nerve to see if my brow would respond to direct stimulation. It did (and I am sorry I went through that now).

It is now 2 1/2 months post surgery and the right side is starting to come back. I can lift the eyebrow some and even make "frown lines" on the right. Never been so happy to see lines on my face.

My doc said he had to cauterize an artery in that area to stop the bleeding and he thinks he probably did some damage to the nerve at that time.

Hope this saves you from going back in for another surgery to see if direct stimulation works. I would give it at least 3 months and keep trying to lift the left side... I think that helps "wake up" the nerve.

Hope this helps,

Trisha10
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Postby marilynn25 » Fri Nov 16, 2007 10:01 am

Trisha10, I am so sorry that it has taken 2 1/2 months for your movement to start coming back. You have got to be the most patient person in the world, or the most resigned--both, I guess. Do you still have a sense of touch up there on your right side when you move it or touch it? I could feel it on my skin if I touched it with my fingers, but not anything else, and no movement. It's finally coming back now, thankfully. But I hope yours hurries up. Please keep me posted about your recovery. I will be thinking about you.

Annie2007, I was actually thinking about having a small hair transplant in the same area (but on both sides) as you, since I have lost so much hair there in the past few years from simply getting older, and what IS still there is so light blond (or white, maybe--don't know anymore :) ) that it can't be seen. I'm even thinking about dyeing my hair a shade darker just to make my fuzz show up more. (Rogaine for women did NOT help.) Anyway, the last thing I want to have happen is for my forehead to get paralyzed again, since I would be scared that this time it would be permanent. Paranoid, maybe, but can't help it. So, you have given me something to think about. I am happy that it returned for you. How long has it been since that happened?

It's incredible how much we miss our eyebrows after we can't use them, isn't it?
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Postby Annie2007 » Tue Nov 20, 2007 12:13 pm

Marilynn25, to answer your question to me:

I just had my 4 month follow up with the transplant doctor and everything is going well with the new graphs. My hair there is about 1 inch long now and more hairs will be growing in, according to MD. It looks very natural. Although I am VERY happy I had it done as it has greatly improved my hairline on that side, it is probably is not as thick as my own expectation imagined it would be. But my assessment could change because every week it appears denser to me. Honestly my head of hair overall is still quite dense, albeit very fine, so maybe getting equal density on that side would be have been difficult. I think that going into it with sparser recipient-area hair might be a plus, but you would want dense enough hair in the donor region that it hides well the resulting scar (mine is about 4(?) inches long and 1 mm wide (he says that’s optimal healing). MD says it would be easy to go back in one day, if I like, to fill in more but quite frankly, after the temp paralysis scare, I’m reluctant to ever get injected again, even for dental work someday! (my dental school friend has since told me all kinds of horror stories regarding anesthetic injections – never take them lightly!! Pass this on!) My numbness/tenderness/itching on my scalp is slowly improving (I think) but the doc just said it may never return to normal completely… hmmm. Oh well, I am still happy I did it. THANK GOODNESS your muscle function returned to normal!!

Warmly,
Annie
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Postby DCNGA » Tue Nov 20, 2007 12:24 pm

I have a couple of questions for you too, Annie.

I have a similar situation as you--one temporal area (more like were men get MPB on either side of a widow's peak, is thinned VERY much. I've been considering micro grafting of hair to that area. Did you have micro grafting?

I have extremely fine hair and have worried over having a "strip" of hair removed from another area, for fear that area would be "bald" or show through.

Was it painful? Downtime? Expensive?

Thanks for any info you can provide.

D
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Postby marilynn25 » Tue Nov 20, 2007 5:24 pm

Thanks for your help, Annie. I am definitely going to take everything you said into consideration before making my decision. It IS a big decision--I didn't know what all was involved. I hope your hair keeps on growing all right--and I don't blame you for not going back for another transplant! :) Please post again to let us know how your hair is doing. Are you posting on the Hair Transplant message boards? I will try to look over there to see.

--Regards, Marilynn
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