Facial Plast Surg 2017; 33(06): 627-638
DOI: 10.1055/s-0037-1607975
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Options in Repositioning the Asymmetric Brow from Paralysis and Trauma

Thomas S. Lee
1   Department of Otolaryngology, Virginia Commonwealth University Medical Center, Richmond, Virginia
Lexie Wang
1   Department of Otolaryngology, Virginia Commonwealth University Medical Center, Richmond, Virginia
Reintine Han
2   American University of Antigua, College of Medicine, Osbourne, Antigua and Barbuda
Moustafa Mourad
3   Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates
Yadranko Ducic
3   Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates
› Author Affiliations
Further Information

Publication History

Publication Date:
01 December 2017 (online)


Brow asymmetry is a relatively common occurrence, especially in the facial plastic surgeon's office. In this article, the authors review causes of brow asymmetry, pertinent anatomy, and a litany of treatment options including nonsurgical and surgical approaches. They offer an algorithm that summarizes the various techniques for management with the goal of tailoring treatment tactics to the individual patient's needs.

  • References

  • 1 Macdonald KI, Mendez AI, Hart RD, Taylor SM. Eyelid and brow asymmetry in patients evaluated for upper lid blepharoplasty. J Otolaryngol Head Neck Surg 2014; 43: 36
  • 2 Nellis JC, Ishii M, Byrne PJ, Boahene KDO, Dey JK, Ishii LE. Association among facial paralysis, depression, and quality of life in facial plastic surgery patients. JAMA Facial Plast Surg 2017; 19 (03) 190-196
  • 3 Hohman MH, Kim SW, Heller ES, Frigerio A, Heaton JT, Hadlock TA. Determining the threshold for asymmetry detection in facial expressions. Laryngoscope 2014; 124 (04) 860-865
  • 4 Ishii LE, Godoy A, Encarnacion CO, Byrne PJ, Boahene KD, Ishii M. What faces reveal: impaired affect display in facial paralysis. Laryngoscope 2011; 121 (06) 1138-1143
  • 5 Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr 2015; 8 (01) 1-13
  • 6 Walrath JD, McCord CD. The open brow lift. Clin Plast Surg 2013; 40 (01) 117-124
  • 7 Bran GM, Börjesson PK, Boahene KD, Gosepath J, Lohuis PJ. Effect of endoscopic brow lift on contractures and synkinesis of the facial muscles in patients with a regenerated postparalytic facial nerve syndrome. Plast Reconstr Surg 2014; 133 (01) 121-129
  • 8 Ellis MF, Daniell M. An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Clin Experiment Ophthalmol 2001; 29 (06) 394-399
  • 9 Lee V, Currie Z, Collin JR. Ophthalmic management of facial nerve palsy. Eye (Lond) 2004; 18 (12) 1225-1234
  • 10 Henstrom DK, Lindsay RW, Cheney ML, Hadlock TA. Surgical treatment of the periocular complex and improvement of quality of life in patients with facial paralysis. Arch Facial Plast Surg 2011; 13 (02) 125-128
  • 11 Leckenby JI, Ghali S, Butler DP, Grobbelaar AO. Reanimation of the brow and eye in facial paralysis: Review of the literature and personal algorithmic approach. J Plast Reconstr Aesthet Surg 2015; 68 (05) 603-614
  • 12 Ducic Y, Adelson R. Use of the endoscopic forehead-lift to improve brow position in persistent facial paralysis. Arch Facial Plast Surg 2005; 7 (01) 51-54
  • 13 Gagyor I, Madhok VB, Daly F. , et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2015; (11) CD001869
  • 14 Madhok VB, Gagyor I, Daly F. , et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2016; 7: CD001942
  • 15 Ahn MS, Catten M, Maas CS. Temporal brow lift using botulinum toxin A. Plast Reconstr Surg 2000; 105 (03) 1129-1135 , discussion 1136–1139
  • 16 Maas CS, Kim EJ. Temporal brow lift using botulinum toxin A: an update. Plast Reconstr Surg 2003; 112 (5, Suppl): 109S-112S , discussion 113S–114S
  • 17 Olson JJ. Balanced botox chemodenervation of the upper face: symmetry in motion. Semin Plast Surg 2007; 21 (01) 47-53
  • 18 Mühlbauer W, Holm C. Eyebrow asymmetry: ways of correction. Aesthetic Plast Surg 1998; 22 (05) 366-371
  • 19 Moody FP, Losken A, Bostwick III J, Trinei FA, Eaves III FF. Endoscopic frontal branch neurectomy, corrugator myectomy, and brow lift for forehead asymmetry after facial nerve palsy. Plast Reconstr Surg 2001; 108 (01) 218-223
  • 20 Booth AJ, Murray A, Tyers AG. The direct brow lift: efficacy, complications, and patient satisfaction. Br J Ophthalmol 2004; 88 (05) 688-691
  • 21 Langsdon PR, Metzinger SE, Glickstein JS, Armstrong DL. Transblepharoplasty brow suspension: an expanded role. Ann Plast Surg 2008; 60 (01) 2-5
  • 22 Cohen BD, Reiffel AJ, Spinelli HM. Browpexy through the upper lid (BUL): a new technique of lifting the brow with a standard blepharoplasty incision. Aesthet Surg J 2011; 31 (02) 163-169
  • 23 Pascali M, Gualdi A, Bottini DJ, Botti C, Botti G, Cervelli V. An original application of the Endotine Ribbon device for brow lift. Plast Reconstr Surg 2009; 124 (05) 1652-1661
  • 24 Paul MD. Subperiosteal transblepharoplasty forehead lift. Aesthetic Plast Surg 1996; 20 (02) 129-134
  • 25 Graham DW, Heller J, Kurkjian TJ, Schaub TS, Rohrich RJ. Brow lift in facial rejuvenation: a systematic literature review of open versus endoscopic techniques. Plast Reconstr Surg 2011; 128 (04) 335e-341e
  • 26 Sidle DM, Loos BM, Ramirez AL, Kabaker SS, Maas CS. Use of BioGlue surgical adhesive for brow fixation in endoscopic browplasty. Arch Facial Plast Surg 2005; 7 (06) 393-397