Why Does The Left Side Of My Temple Itch Occasionally After A Custom Forehead-Brow Bone Implant?

Q: Dr. Eppley, I received a custom brow/forehead implant as well a total midface implant four years ago. Ever since the surgery, my left temple has always felt a little different than my right. Closer to the time of surgery, I would occasionally get sharp twinges of discomfort around the left edge of the implant. I haven’t felt that discomfort in a long time, but that area will sometimes briefly itch for seemingly no reason. That area also feels a little more sensitive than the same spot on the right side, even years later. All of these sensations can be traced back to the time of surgery. The left side was also the side that experienced more significant bruising.

This is not a serious issue by any means, but I want to check in to know if there might be anything I should keep in mind going forward. I am extremely happy with my implants and want them to stay healthy for the rest of my life.

A: Good to hear from you after our surgical adventure from 2020. Those left-sided symptoms suggest a more neurologic basis as abnormal sensations from one of the lateral branches of the sensory supraorbital nerve which could have been more stretched form the greater swelling/bruising on that side. That is what itching would indicate as opposed to a problem with the implant. Such small terminal branches of a sensory nerve are either trying to recover or just exhibit an abnormal sensation from time to time given the stretch injury. When we look at the rather ‘extreme’ nature of the augmentation (implant surface area) and the periorbital incisions needed to do it it is probably surprising that is the only relatively minor sequelae from the surgery. Whether that will ever change over time remains to be seen.

Attached is an endoscopic picture from your surgery showing the left supraorbital nerve and vessels as they exit from the brow bone and the dissection needed to make the space for the brow bone implant. So it is easy to see how small nerve branches can get severely stretched.

Dr. Barry Eppley

World-Renowned Plastic Surgery