Q: Dr. Eppley, I am interested in nerve repair. I had eyebrow hair transplants three times. The last time I had done was over one year ago. Since then I have had electric, shock like, tingling, numbness pain and crawling sensations that are felt along the eyebrows and down sides of nose. Smoking and stress worsen nerve pain and nothing relieves it. It lasts all throughout the day. I feel I have had a nerve cut in that area and wondered if I would be a candidate for surgical repair to this area? It causes much distress in my life. I would be happy to hear any input from you
A: With eyebrow hair transplants I can theoretically see that injury to the nerves under the eyebrows could account for either pain or sensory loss by either the injection of a local anesthetic into the eyebrows or from the creation of a needle tract for the placement of the transplanted hair follicle. The distribution of the pain should help determine if this could be the source.
The only nerves that are under the eyebrows are the supratrochlear and supraorbital nerves. In detailing the anatomy of the supratrochlear nerve, it is a branch of the frontal nerve (1st division of the opthalmic division of the fifth cranial nerve. It comes out right below the inside the brow bone and comes up onto the forehead in the glabellar muscle region. It supplies feeling to the skin of the upper eyelid and the glabellar region of the forehead. The larger supraorbital nerve, also a branch of the frontal nerve, comes out either right under or on the brow bone right below the inner half the eyebrows and supplies feeling to the frontal sinus and skin of the forehead all the way up into the scalp. As you can see from this anatomical description, injury to either of these nerves does not account for the distribution of the pain down along the sides of the nose. That is the vexing part of your pain symptoms
But using the analogy where there is smoke, search for a fire. It is fair to say that it must be some type of injury to these nerves. At this late date, actual repair of a cut nerve if it existed would not be possible. All that can be done at this point is an endoscopic approach to decompress and release the supraorbital and supratrochlear nerves, possibly wrapped in fat graft to prevent secondary scar tissue formation around them. This is exactly what is done in migraine surgery. Whether this would work for you is unknown. One test you could do is to inject Marcaine local anesthetic around these nerves to determine of that provides temporary symptom relief. If it did that would provide you with great confidence that is the source of the problem and an endoscopic release may provide some symptom improvement.
Dr. Barry Eppley