The rational of forehead lifting in patients with chronic facial
Received: 10 July 2012 /Accepted: 5 September 2012 /Published online: 23 September 2012
Background The incidence of permanent facial sequels
in patients with Bell’s palsy is about 30 % and results
in impaired mimic expression of both midface and
forehead in varying degrees. Even at rest, most
patients experience an imbalance of their facial fea-
tures. In this article, static correction of brow imbal-
ance was evaluated in patients with sequels after
unilateral facial palsy.
Methods Thirty-one patients with sequels of Bell’spalsy
underwent surgery with endoscopic forehead lift. Brow
position was geometrically assessed pre- and postopera-
tively. The validated self-assessment instrument for
quality of life [Short Form 36(SF-36)] was completed
prior to and after surgery. The follow-up period was
Results A notable improvement in the position of the
brows was demonstrated over time with lasting results.
All patients experienced an improvement in facial sym-
metry and balance at rest. However, no significant
difference could be shown using SF-36 pre- and
Conclusion Endoscopic forehead lift combined or as an
isolated procedure is a valuable instrument to correct
sequels of Bell’s palsy.
Level of Evidence: Level IV, therapeutic study.
Keywords Bell’s palsy
Bell’s palsy accounts for approximately 70 % of all acute
peripheral palsies and affects 30 patients/100,000 individuals/
year . Seventy percent of patients with a total facial palsy heal
spontaneously within 3 months after onset of the disease, where-
as the remaining 30 % suffer from permanent facial sequels.
Despite a wide range of clinical symptoms in partial
facial palsy, all patients express various degrees of social
disability and reduced quality of life related to the disease.
Even at rest, most patients complain of imbalance of their
facial features and request restoration of as much symmetry
and function as possible. In patients with facial palsy, the
frontal branch paralysis usually results in functional loss and
atrophy of the frontalis muscle, which manifests as ipsilat-
eral brow ptosis due to unopposed gravity. In addition,
variable asymmetries as a result of contralateral muscular
hyperactivity contribute to the pathology .
The aim of this article is to retrospectively investigate
whether or not endoscopic forehead lift meets patients’
expectations and improves quality of life and self-esteem.
The secondary aim is to study if the Short Form 36 (SF-36)
questionnaire is a useful instrument in evaluating quality of
life in this clinical setting.
Patients and methods
Thirty-one patients with sequels of Bell’s palsy were operated
on with endoscopic forehead lift as an isolated procedure (n0
11) or in combination with intraoral subperiosteal midface lift
(n020). Indication for surgery was asymmetry of the brows due
to reduced or lacking frontal muscular function. All patients
complained of pressure and discomfort at the lateral and supe-
rior orbital area. Mean age of the patients was 51.9 (range 43 to
Å. Edsander-Nord (*)
Department of Molecular Medicine and Surgery,
Section of Plastic Surgery, Karolinska Institutet,
Eur J Plast Surg (2013) 36:83–86