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One of the most common facial lines that are formed with aging  due to repetitive muscle activity are the vertical glabellar lines. These are vertical skin creases that develop in between the eyebrows and are classically called the ‘11s’ because most people will develop a symmetrically pair of them. While this is the most common presentation it is not their only presentation as a single midline groove, asymmetric paired lines and even three vertical lines can develop. Regardless of their presentation they occur because of repetitive muscle activity of the glabellar musculature.

The primary treatment for glabellar vertical lines is the injection of neuromuscular blocking agents such as Botox, Dysport and Xeomin. These produce a temporary weakening effect on the muscle which softens deep vertical lines and can make more superficial ones disappear.  This is actually what Botox, the original aesthetic neuromuscular drug, was originally approved for by the FDA in 2002….the treatment of glabellar wrinkle lines.

While non-surgical injection therapy will always remain the primary treatment of glabellar vertical lines, there are surgical treatment methods. As part of most endoscopic brow lifts, avulsion or electrocautery treatment is done to the glabellar musculature to diminish their activity on the overlying skin.

Surgical glabellar muscle treatment can also be done through an upper blepharoplasty surgery. Through the medial or inner aspect of the upper blepharoplasty incision the glabellar muscles can be partially removed between the supraorbital nerve and the frontonasal bone. To lower the chance of a return of the muscle activity and to prevent a contour deformity in the glabellar area due to the soft tissue removal, interpositonal fat grafting can be done. If a lower blepharoplasty is being performed at the same time, this is a convenient source of fat graft harvest from the infraorbital fat pockets.

Surgical glabellar muscle resection has merit when other procedures are being dnje around the glabellar area. Short of a browlift, the upper blepharoplasty provides convenient access to perform it as part of an overall anti-aging surgery. While glabellar muscle resection will never work as well as injectable neuromuscular modulators, it provides an opportunity to create some permanent reduction in muscle activity that may also result in lesser volume or diminished use of injectable treatments,

Dr. Barry Eppley

Indianapolis, Indiana

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