Due to the paralysis of the frontal branch of the facial nerve (ramus frontotemporalis) the frontalis muscle (m. frontalis) is paralyzed on one side. Since the forehead muscle normally has a resting tension (resting tone) and fixes the eyebrow at or above the level of the bony edge of the eye socket, its slackening also results in a one-sided lowering of the eyebrow and even of the upper eyelid below. This leads to both functional impairment and aesthetical disturbance. In severe cases, the field of vision may be restricted: the patient describes "a black roof" at the upper and outer edge of his field of vision. The resting symmetry and the overall harmony of the face can be permanently disturbed even by a slightly asymmetrical brow height.
For improvement, surgical brow lifting can be performed by a brow-pexy or an endocopic brow lift (access via small incisions with hidden scars from the parietal region).
This lady showed a distinct low brow on the left side in an incomplete paresis due to paralysis of the forehead muscle. It is impressively demonstrated how the so-called brow ptosis also makes the eye appear somewhat smaller. The overall harmony of the face and symmetry at rest could be elegantly and effectively improved by an endoscopic elevation of the periorbital complex (eyebrow and upper eyelid). The method is performed with a camera system and fine instruments through small incisions in the hair-bearing area of the scalp and leaves no visible scars.
The correction of the eyebrow position is of critical importance for the symmetry in the face: in this elderly man with facial paralysis on the left, a massive eyebrow depression as well as a massively weakened lower eyelid with a distinct depression is demonstrated in the left image before the operation. The consequences are a noticeably tired facial expression with clear asymmetry at rest, as well as a dry eye with conjunctivitis due to the undirected tear film. Right picture: After raising the eyebrows to a symmetrical level with the non-paralyzed opposite side and a reconstruction of the lower eyelid with the patient's own tissue, both the inflammation of the connective tissue is corrected and a significantly more harmonious appearance is achieved. The patient no longer complains of eye discomfort and is happy about a significant improvement in his appearance.
Facial paralysis due to tumor resection. Despite intensive exercises with physical therapy, the so-called "brow depression" (low brow on the right) could not be improved in this patient, because the muscle tone of the frontal muscle (Musculus frontalis) had been lost as a typical phenomenon of a "frontal branch paresis" (paralysis of the r. frontalis). By raising the periorbital complex (endoscopic brow lift) and upper eyelid blepharoplasty symmetry could be improved significantly.
In this patient, too, the change in the field of vision before and after elevation of the periorbital complex can be well assessed already with the naked eye. Postoperatively, the right pupil is no longer obscured by the brow. In this case, a combination surgery Labbé temporal transfer and open elevation of the periorbital complex) was performed.