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Ask Dr. Barber

baberpicQ. I had a face lift 2 months ago and I now cannot raise   one side of my forehead?  I had the surgery done in South America and I am not able to get back to the surgeon for a follow up.  Will this problem get better?

A. Medical tourism is growing in popularity in our country, with Americans going to foreign countries to have all types of surgery, including plastic surgery.  In most instances, things tend to work out, but on occasion there can be problems.  From the brief description of your situation, it sounds like you may have experienced an injury to the nerve (temporal branch of the facial nerve) that supplies the forehead and eyebrow muscle.  Since you say that the problem is only on one side, it means that the nerve on one side of the face has been injured and the nerve on the other side is fine.  The temporal nerve is always at risk for injury during a facelift but fortunately rarely incurs damage.  The result of an injury to this nerve is that the eyebrow on the affected side is paralyzed and is not able to elevate.  Also, the lines on the forehead tend to disappear which is actually not a bad thing, except for the fact that the lines are still present on the unaffected side, causing some asymmetry in the appearance of the forehead.

As for treatment, unfortunately there is very little that can be done other than wait and hope that the nerve will recover and the muscle function in the forehead returns.  If the nerve was simply bruised during the surgery, it is likely going to get better, but may take up to a year for recovery.  Recovery can be partial or complete, meaning that with a partial recovery the forehead muscle function returns with some residual weakness of the forehead.  If the nerve completely healed, normal appearance of the forehead would return.  One final comment about medical tourism; anyone considering leaving the country for surgery needs to be aware of the disadvantages of seeing a doctor in another country, that is that follow up back in the foreign country is often difficult, and finding a local doctor to take care of you after you have had surgery with another doctor out of the area can sometimes be a challenge.

 

Q. I had a mastectomy for breast cancer about 6 years ago and at the time of my diagnosis was so distraught that I did not consider breast reconstruction.  I am doing great now and would like to know what my options are for breast reconstruction.  I am 47 years old, healthy, normal weight (maybe a few pounds over) and work out regularly.  I have a very supportive family who wants me to do whatever makes me happy.

A. First of all, congratulations on being a survivor!  You sound like you have done very well.  As for breast reconstruction, you still have the same reconstructive options that you had at the time of your mastectomy.  These options include reconstruction with a tissue expander to stretch the skin at the mastectomy site, followed by placement of a permanent breast implant. This type of reconstruction is a two stage surgery, which typically take about 6 to 9 months to complete.  It is slightly less complicated than other forms of reconstruction and typically has less down time.  A second option is to create a breast using your own skin and fat, with the donor site most often being the abdominal area.  This technique of using your own tissue has the advantage of giving the patient a more natural feel and look to the reconstructed breast.  The disadvantage is that it is a more complex reconstruction with a slightly higher complication rate and a longer recovery time.  A consultation with a board certified plastic and reconstructive surgeon who concentrates on reconstructive breast surgery would be important for you to get all the information you need to make an informed decision.

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William Byron Barber II, M.D.

has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com

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