An Old Man with Droopy Eyebrow

This 62 year-old man was referred for droopy eyelid from the polyclinic. Examination revealed that the right pupil was covered by the upper eyelid skin which interfered with his vision especially during driving. The past history revealed that he suffered from right facial paralysis two years earlier. Although most of the function of the facial muscles have now returned, the right upper forehead muscle remained severely affected. This has resulted in droopy eyebrow which in turn caused the eyelid to droop over the right eye.

Right eye covered by the upper eyelid skin because of eyebrow droop.

 The picture on the right shows the right forehead muscle is non-functioning

 due to previous facial paralysis.

There were two solutions to the problem: either the excess eyelid could be excised  or the eyebrow could be lifted to open the eye. If the excess eyelid were excised, the eyebrow would droop further and aesthetically the result is poor. The best solution was to lift the eyebrow which would also balance the height of the two eyebrows to give an aesthetically pleasing result.

Steps in lifting the eyebrow directly. a. The height of the droopy eyebrow is lifted 

to the same level as the normal side; b and c. The amount of skin that needs to be 

excised to achieve this is drawn; d. the height is rechecked; e. the skin is excised 

and f. closure of the defect lift the eyebrow, initially the amount of lift is more 

than expected due to suture tension this would loosen over the next few days. 

Good height at one week postoperative.