Advertisement

Transpalpebral Corrugator Resection: 25-Year Experience, Refinements and Additional Indications

Abstract

The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has developed newer indications for this procedure. These refinements, indications and the related new video are the subject of this report. The modifications in the technique are as follows: After elevation of the skin and the orbicularis muscle and dissection under the muscle, a thin layer of the depressor supercilii muscle overlying the darker and more friable corrugator supercilii muscle is removed. A fairly constant branch of the supraorbital nerve piercing this muscle medially is first identified on the surface and followed deep in the muscle using a mosquito hemostat. The muscle is then lifted, and then, the same nerve branch is identified above the periosteum. The segment of the muscle lateral to this nerve is then isolated and removed by first transecting it medially and then lateral to the nerve. A cephalic segment is isolated and removed using the coagulation power of the cautery to minimize the postoperative bleeding. The rest of the muscle is then removed in a piecemeal fashion as thoroughly as possible, including a lateral segment of the procerus muscle, the end point being visualization of the subcutaneous fat. If the intention of the surgery is to treat frontal migraine headaches, the supratrochlear and supraorbital arteries are also removed. If the nerve and vessel pass through a foramen, a foraminotomy is carried out on patients with migraine headaches. Two to three cc of fat is injected in the glabellar and corrugator sites in most patients to avoid any depression and to restore the lost glabellar volume. Beyond patients with male pattern baldness, those with a long forehead and those with overactive frown muscles but optimal eyebrow positions, this technique is now being used for those with proptosis, exophthalmos and those with eyelid ptosis who would not undergo ptosis correction to prevent elevation of the eyebrows, which exaggerates the proptosis or makes the eyelid ptosis more discernible. Additionally, a common indication for this surgery is in patients with frontal migraine headaches. This report highlights the refinements in the transpalpebral corrugator resection that have been implemented over the last 25 years and offers additional indications for its utilization.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. 1.

    Knize DM (1995) Transpalpebral approach to the corrugator supercilii and procerus muscles. Plast Reconstr Surg 95:52–60

  2. 2.

    Guyuron B, Michelow BJ, Thomas T (1995) Corrugator supercilii muscle resection through blepharoplasty incision. Plast Reconstr Surg 95:691–696

  3. 3.

    Guyuron B, Behmand R, Green R (1999) Shortening of the long forehead. Plast Reconstr Surg 103(1):218–223

  4. 4.

    Guyuron B (2006) Endoscopic forehead rejuvenation: I. Limitations, flaws, and rewards. Plast Reconstr Surg 117(4):1121–1133

  5. 5.

    Guyuron B, Varghai A, Michelow BJ et al (2000) Corrugator supercilii muscle resection and migraine headaches. J Plast Reconstr Surg 106:429–434

  6. 6.

    Guyuron B, Tucker T, Davis J (2002) Surgical treatment of migraine headaches. Plast Reconstr Surg 109:2183–2189

  7. 7.

    Guyuron B, Kriegler JS, Davis J et al (2005) Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg 115:1–9

  8. 8.

    Guyuron B, Reed D, Kriegler JS et al (2009) A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg 124:461–468

  9. 9.

    Guyuron B, Kriegler JS, Davis J, Amini SB (2011) Five-year outcome of surgical treatment of migraine headache. Plast Reconstr Surg 127(2):603–608

  10. 10.

    Chepla KJ, Oh E, Guyuron B (2012) Clinical outcomes following supraorbital foraminotomy for treatment of frontal migraine headache. Plast Reconstr Surg 129(4):656e–662e

  11. 11.

    Dirnberger F, Becker K (2004) Surgical treatment of migraine headaches by corrugator muscle resection. Plast Reconstr Surg 114:652–657

  12. 12.

    Poggi JT, Grizzell BE, Helmer SD (2008) Confirmation of surgical decompression to relieve migraine headaches. Plast Reconstr Surg 122:115–122

  13. 13.

    Janis JE, Dhanik A, Howard JH (2011) Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg 128(1):123–131

  14. 14.

    Liu MT, Chim H, Guyuron B (2012) Outcome comparison of endoscopic and transpalpebral decompression for treatment of frontal migraine headaches. Plast Reconstr Surg 129(5):1113–1119

  15. 15.

    Guyuron B, Yohannes E, Miller R, Chim H, Reed D, Chance M (2014) Electron microscopic and proteomic comparison of terminal branches of the trigeminal nerve in patients with and without migraine headaches. Plast Reconstr Surg 134(5):796e–805e

Download references

Author information

Correspondence to Bahman Guyuron.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 500811 kb)

Supplementary material 1 (MP4 500811 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Guyuron, B., Son, J.H. Transpalpebral Corrugator Resection: 25-Year Experience, Refinements and Additional Indications. Aesth Plast Surg 41, 339–345 (2017). https://doi.org/10.1007/s00266-017-0780-8

Download citation

Keywords

  • Corrugator supercilii muscle
  • Transpalpebral