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 © July 2011
Guillermo Blugerman MD,a Diego Schavelzon MD,a Friedrich Anderhuber MD,b Lorena Martinez MD,a Anastasia Chomyzsyn MD,a
aCentro B&S Excelencia en CirugÍa Plástica, Buenos Aires, Argentina bZentrum für Theoretisch-Klinische Medizin and Institut für Anatomie Medizinische Universität Graz, Austria
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involved, and then the loops of thread are withdrawn from orifice A.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.
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
