Advertisement

Aesthetic Plastic Surgery

, Volume 41, Issue 2, pp 339–345 | Cite as

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

  • Bahman GuyuronEmail author
  • Ji H. Son
Original Article Oculoplastic

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.

Keywords

Corrugator supercilii muscle Transpalpebral 

Notes

Compliance with Ethical Standards

Conflict of interest

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

Supplementary material

Supplementary material 1 (MP4 500811 kb)

References

  1. 1.
    Knize DM (1995) Transpalpebral approach to the corrugator supercilii and procerus muscles. Plast Reconstr Surg 95:52–60CrossRefPubMedGoogle Scholar
  2. 2.
    Guyuron B, Michelow BJ, Thomas T (1995) Corrugator supercilii muscle resection through blepharoplasty incision. Plast Reconstr Surg 95:691–696CrossRefPubMedGoogle Scholar
  3. 3.
    Guyuron B, Behmand R, Green R (1999) Shortening of the long forehead. Plast Reconstr Surg 103(1):218–223CrossRefPubMedGoogle Scholar
  4. 4.
    Guyuron B (2006) Endoscopic forehead rejuvenation: I. Limitations, flaws, and rewards. Plast Reconstr Surg 117(4):1121–1133CrossRefPubMedGoogle Scholar
  5. 5.
    Guyuron B, Varghai A, Michelow BJ et al (2000) Corrugator supercilii muscle resection and migraine headaches. J Plast Reconstr Surg 106:429–434CrossRefGoogle Scholar
  6. 6.
    Guyuron B, Tucker T, Davis J (2002) Surgical treatment of migraine headaches. Plast Reconstr Surg 109:2183–2189CrossRefPubMedGoogle Scholar
  7. 7.
    Guyuron B, Kriegler JS, Davis J et al (2005) Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg 115:1–9PubMedGoogle Scholar
  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 124:461–468CrossRefPubMedGoogle Scholar
  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):603–608CrossRefPubMedGoogle Scholar
  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–662eCrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dirnberger F, Becker K (2004) Surgical treatment of migraine headaches by corrugator muscle resection. Plast Reconstr Surg 114:652–657CrossRefPubMedGoogle Scholar
  12. 12.
    Poggi JT, Grizzell BE, Helmer SD (2008) Confirmation of surgical decompression to relieve migraine headaches. Plast Reconstr Surg 122:115–122CrossRefPubMedGoogle Scholar
  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):123–131CrossRefPubMedGoogle Scholar
  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):1113–1119CrossRefPubMedGoogle Scholar
  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–805eCrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  1. 1.ClevelandUSA

Personalised recommendations