Successful browlift surgery is based on several key technical maneuvers. These include periosteal release, muscle resection and brow elevation with or without fixation. These steps allow for the brows to not only be elevated but hopefully reduce the amount of chronic muscle contraction in the glabellar region. Patients and some plastic surgeons hope that the muscle effect creates a result that is similar to a ‘Botox-like’ effect between the eyebrows.
But many patients that have excessive frowning, also known as 1s or the famous 11s, don’t need a browlift. While Botox is a tremendously simple and effective treatment for frowning, the need for regular injection treatments has some patients desiring a more permanent one-time surgical treatment. Surgical resection of the glabellar muscles would be an effective treatment but direct access to the muscle area is limited by scan and nerve location concerns. Resection of these muscles can be done either from above through an endoscope or from below through an upper eyelid incision.
Is the superior endoscopic or the inferior eyelid approach better for muscle resection in this area? There are surgeon advocates on both sides of that discussion. I have done it both ways and each method has its own unique advantages and disadvantages.
In the May 2012 Aesthetic Surgery Journal, a study out of Wisconsin compared the transpalpebral (upper eyelid) and endosopic approaches in the resection of the corrugator supercilii muscles. Using cadaver faces, the study looked at the completeness of resection of the corrugator muscle with the transpalpebral and endoscopic techniques. After the procedures were completed on both sides, the tissues were removed and the amount of corrugators muscle resection evaluated. In 95% of the cadaver halfs, complete muscle releaser was obtained. The only failed instance was in one case of endoscopic release. This report demonstates that either method can achieve good muscle release and is operator-dependent.
For the patient seeking a ‘surgical Botox’ procedure for frowning, either endoscopic or upper eyelid approach can be used for the muscle resection. For the majority of patients the upper eyelid approach is often more appealing particularly if they are in need of a blepharoplasty procedure as well.
Dr. Barry Eppley
Indianapolis, Indiana