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Aesthetic Plastic Surgery

, Volume 35, Issue 4, pp 516–521 | Cite as

Eliminating Frown Lines with an Endoscopic Forehead Lift Procedure (Corrugator Muscle Disinsertion)

  • Farhad Hafezi
  • Bijan NaghibzadehEmail author
  • AmirHossein Nouhi
  • Ghazal Naghibzadeh
Original Article

Abstract

Background

In certain cases of endoscopic forehead lift without muscle resection, patients were incidentally noted to develop weakness or loss of their ability to frown during the postoperative period despite intact musculature. This finding suggested the possibility of decreasing frown strength using the disinsertion of the relevant muscles. This finding persuaded the authors to try to eliminate or decrease the sensory problems resulting from open or endoscopic frowning muscle resection by disinserting these muscles. We therefore sought to determine the efficacy of a brow/forehead lift that involved disinsertion rather than muscle resection.

Methods

From September 2004 through December 2006, 22 endoscopic forehead lifts (20 females and 2 males) were performed using the conventional corrugator muscle resection technique (group 1). From January 2007 through October 2009, 43 patients (38 females and 5 males) underwent endoscopic forehead lift with a muscle-preserving technique (group 2). In both groups, small scalp incisions were made, and an endoscope was used to elevate the brows and forehead to perform glabellar and forehead muscle resection in group 1 and disinsertion of the frowning muscles in group 2. The skin of the forehead was then reanchored to a more superior location using sutures attached to deep temporal fascia as well as outer table screws and skin staples.

Results

Aesthetically pleasing eyebrow and forehead with reduced power in the frowning muscles were achieved in the majority of patients in both groups. A significant decrease in the depth of vertical and horizontal glabellar creases was obtained in these patients. In group 1, 19 of 22 patients completely lost the ability to frown and 3 patients (13.6%) suffered permanent sensory loss. In group 2, 33 of 43 patients lost their ability to frown but only 2 cases (4.5%) developed minimal unilateral forehead partial sensory deficit after a 12-month follow-up period.

Conclusion

Disinsertion of the corrugator supercilli, procerus, or orbicularis oculi muscles can decrease contractility with less chance of damaging nearby or intermingled sensory nerves than offered by resection.

Keywords

Corrugator disinsertion Muscle weakness Sensory loss 

Notes

Disclosures

F. Hafezi, B. Naghibzadeh, A. Nouhi, and G. Naghibzadeh have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Rafaty FM (1981) Elimination of glabellar frown lines. Arch Otolaryngol 107(7):428–430PubMedCrossRefGoogle Scholar
  2. 2.
    Knize DM (2000) Muscles that act on glabellar skin: a closer look. Plast Reconstr Surg 105(1):350–361PubMedCrossRefGoogle Scholar
  3. 3.
    Presti P, Yalamanchili H, Honrado CP (2006) Rejuvenation of the aging upper third of the face. Facial Plast Surg 22(2):91–96PubMedCrossRefGoogle Scholar
  4. 4.
    Abramo AC (1995) Anatomy of the forehead muscles: the basis for the videoendoscopic approach in forehead rhytidoplasty. Plast Reconstr Surg 95(7):1170–1177PubMedCrossRefGoogle Scholar
  5. 5.
    Nemoto M, Uchinuma E, Yamashina S (2002) Three-dimensional analysis of forehead wrinkles. Aesthetic Plast Surg 26(1):10–16PubMedCrossRefGoogle Scholar
  6. 6.
    Troilius C (2004) Subperiosteal brow lifts without fixation. Plast Reconstr Surg 114:1595-1603; discussion 1604-5Google Scholar
  7. 7.
    Core GB, Vasconez LO, Askren C et al (1992) Coronal face-lift with endoscopic techniques. Plast Surg Forum 15:227Google Scholar
  8. 8.
    Mavrikakis I, DeSousa JL, Malhotra R (2008) Periosteal fixation during subperiosteal brow lift surgery. Dermatol Surg 34(11):1500–1506PubMedCrossRefGoogle Scholar
  9. 9.
    Walden JL, Brown CC, Klapper AJ, Chia CT, Aston SJ (2005) An anatomical comparison of transpalpebral, endoscopic, and coronal approaches to demonstrate exposure and extent of brow depressor muscle resection. Plast Reconstr Surg 116(5):1479–1487PubMedCrossRefGoogle Scholar
  10. 10.
    Standring S (2004) Gray’s Anatomy: The Anatomical Basis of Clinical Practice, 39th ed. edn. London, Churchill Livingstone, pp 502–503Google Scholar
  11. 11.
    Nahai F (2005) The Art of Aesthetic Surgery: Principles and Techniques, Vol. 2. Quality Medical Publishing, Inc., St. Louis, p 846Google Scholar
  12. 12.
    Brand PW (1985) Clinical Mechanics of the Hand. CV Mosby, St. LouisGoogle Scholar
  13. 13.
    Brand PW, Beach RB, Thompson DE (1981) Relative tension and potential excursion of muscles in the forearm and hand. J Hand Surg Am 6:209–219PubMedGoogle Scholar
  14. 14.
    Guyton A, Hall J (2006) Textbook of Medical Physiology, 11th edn. Saunders, Philadelphia, pp 72–83Google Scholar
  15. 15.
    Tabatabai N, Spinelli HM (2007) Limited incision nonendoscopic brow lift. Plast Reconstr Surg 119(5):1563–1570PubMedCrossRefGoogle Scholar
  16. 16.
    Caminer DM, Newman MI, Boyd JB (2006) Angular nerve: new insights on innervation of the corrugator supercilii and procerus muscles. J Plast Reconstr Aesthet Surg 59(4):366–372PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011

Authors and Affiliations

  • Farhad Hafezi
    • 1
  • Bijan Naghibzadeh
    • 2
    Email author
  • AmirHossein Nouhi
    • 3
  • Ghazal Naghibzadeh
    • 4
  1. 1.Department of Plastic SurgeryIran University of Medical Sciences, St. Fatima HospitalTehranIran
  2. 2.Department of ENT SurgeryShahid Beheshty University of Medical Sciences, Loghman Hakim HospitalTehranIran
  3. 3.TehranIran
  4. 4.Tehran University of Medical SciencesTehranIran

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