Corrugator Supercilii Muscle Terminal Nerve Ablation Using a Novel Thread Technique for the Treatment of Hyperdynamic Vertical Glabellar Furrows

July 2011 | Volume 10 | Issue 7 | Original Article | 762 | Copyright © 2011

Abstract

Background: A novel percutaneous corrugator supercilii muscle terminal nerve CSMTN ablation technique is proposed for the treatment of hyperdynamic vertical glabellar furrows (HVGF).
Technique: Two surgical marks are placed on each eyebrow. One is placed at the level of the lateral canthus and the second at the outer border of the limbus. At each of the four marks, the following steps are carried out: (1) a guiding needle is used to punch the frontal skin at 3 mm above the eyebrow (orifice A) and will then travel deeply at the level of the supraperiostium and emerge outside the skin 3 mm below the eyebrow (orifice B) at the palpebral skin; (2) the needle is then reentered exactly at orifice B and will travel underneath the skin at a more superficial level in the subcutaneous layer and then emerge outside exactly at orifice A. Both ends of the thread are gently pulled in a sawing motion with counter tension until no more resistance is felt from the anatomical structures involved, and then the loops of thread are withdrawn from orifice A.
Results: Forty-seven subjects underwent bilateral CSMTN ablation. In the first 10 cases, the authors performed only one neurotomy per eye and observed a 50 percent HVGF recurrence rate. Then, the authors chose to perform two neurotomies per side and had a three percent recurrence rate (1/37) with a high degree of patient satisfaction. Major complications such as deforming hematomas, eyelid ptosis, abscess, scar formation or adhesions were not observed during follow up.
Conclusion: This novel technique may represent a simple and permanent solution for HVGF.

J Drugs Dermatol.2011;10(7):762-765.

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INTRODUCTION

Hyperdynamic vertical glabellar furrows (HVGF) are an aesthetic concern in the forehead. Several techniques have been applied in an attempt to eliminate HVGF, including botulinum toxin injection,1 surgical2 or radiofrequency nerve ablation,3 muscle ablation4,5 or percutaneous myotomy.6 All these techniques present inherent limitations due to their invasive nature (i.e., surgical resection) or their short-lived action (i.e., botulinum injection). Thus, a minimally invasive procedure that can eliminate the HVGF permanently is still warranted.

Further insight into periorbital muscle distribution and innervation has allowed the development of novel techniques to reduce HVGF.7-9 The corrugator supercilii muscle is located frontally underneath the eyebrow and its contraction draws the medial end of the eyebrow downward, and wrinkles the forehead vertically, thus, generating the HVGF (Figures 1-3). Several authors have shown that either endoscopic or open resection of the corrugator supercilii muscle's terminal nerve (CSMTN) can effectively reduce HVGF formation; however, these techniques are performed in patients undergoing facial lifting or blepharoplasty and require a longer convalescent time. In this paper, the authors describe a novel percutaneous technique that achieves CSMTN ablation for the treatment of HVGF.

TECHNIQUE

During the preoperative visit, the surgeon should discuss patient's expectations, surgical results and risks. The patient should be informed that only dynamic (and not static) wrinkles are being treated by the procedure. Data regarding concomitant medications and standard coagulation studies must be checked in order to evaluate bleeding risk.

In this study, all patients were seen by a senior surgeon and photographed prior to and after the procedure. Photographs were taken at rest and during muscle contraction.

Prior to the procedure, all subjects were adequately marked with a fiber-tipped blue marking pen. Two marks are placed on

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