Q: Dr. Eppley, I am interested in facial reconstruction. I had a motorcycle accident caused a de-gloving injury and tore my skin down off my forehead in a triangular fashion starting at the widows peak tearing down over right eye stopping at mid eyebrow and on left side across and down ending next outer edge of left eye between outer edge of eyebrow and left eye itself.
A few things… my left eye you see the eyebrow is high and it creeps up higher as day goes on at night it becomes quite pronounced. This eyebrow creep was initially mediated with botox injections after orbital fracture surgery. Ten years ago a plastic surgeon took a piece of my skull over my left eye about 3 inches behind hairline to rebuild area fractured under left eye. This area of skull is now an indentation about 3×2 inches oval shape concaveing about a 1/4 inch depth that is trouble some to me and keeps me from cutting hair as I would like (short) has odd sensations to feel and is deformed enough to bring attention same as eyebrow .
I have a similar situation of strange sensation’s over my left eye it is hypersensitive. My brow as a result of the emerge nay nature of accident was sewed together in flight for life travel and although curative left me with funny brow lines that are mess matched and the creeping eyebrow.
A separate issue came about from skin cancer surgery on left side of nose and has left my face dropping pulled or distorted on the lower left. See the nasolabal fold is not equivalent nor within normal range of normal nonequivalent range. It caused a pulling too from under left eye and in conjunction with orbital surgery left the field under left eye different then right eye.
I further think I should look at my nose it was broken 2 x and my left nostril runs at far less capicity then right. I always have to clear my throat and feel dripping of mucus especially when sleeping down my throat.
I was hoping for some help with breathing and stopping the sinus draining down my throat as well as more balanced face and correction of indentation and brow.
A: Thank you for sending your picture and providing the detailed description of your facial concerns. To ensure I have an accurate listing of your concerns and their potential facial reconstruction treatments, I enumerate the following;
1) Skull Defect From Bone Graft Harvest Site – This is a partial thickness skull defect from the removal of the outer table of the skull from the bone graft harvest. This can be completely built out/leveled by the application of hydroxyapatite cement.
2) Left Eyebrow Elevation/Asymmetry – This is the result of the transection of the frontal branch of the facial nerve from the oblique laceration that went down to the outside of the eye. This cut directly across the path of the nerve that is responsible for forehead movement. This has resulted in permanent paralysis of that side of your forehead. Over time the paralyzed eyebrow continues to retract upward due to lack of any downward muscle pull. While motor nerve function can never be restored to the paralyzed eyebrow, it may be possible to realign the scar line so that the eyebrow is brought down lower and the horizontal wrinkle lines match up better.
3) Left Eyebrow Dysesthesia/Sensations – Like the frontal branch of the facial nerve, the large sensory supraorbital nerve coming out of the brow bone has been similarly cut. While the nerve ends are long past being able to be repairs, the trunk of the nerve where it comes out of the bone could be released from the scar and perhaps this may improve the strange sensations.
4) Left Lower Eyelid Contracture – The left side of the nose was reconstructed with a rotational nasolabial flap. This is a concept of ‘robbing Peter to pay Paul’. As a result there is a relative tissue deficiency between the lower eyelid and the nasolabial fold, making it tighter than the other side. An effective treatment strategy would be fat injections to try and loosen up the tissues.
5) Nasal Airway Obstruction – I can’t obviously know what the inside of your nose looks like and this will require a CT scan for evaluation/confirmation of internal nasal anatomic obstruction. Septal straightening and inferior turbinate reduction surgery may be appropriate
These are my initial thoughts,
Dr. Barry Eppley