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Glabellar wrinkling is a well known aesthetic forehead deformity caused by the action of the procerus and corrugator muscles. Better known as the ‘11s’ it usually appears as a pair of vertical wrinkle lines between the eyebrows which can also appear as a single or even triple line. Usually it is treated quite effectively by Botox and filler injections provided that it is not too  severe. (deep) But over time and with strong facial expressions, particularly in men, the wrinkle line can become inverted (v-shaped) and fixed and is now known as a furrow. and refractory to injection treatments. As the name implies it appears a long narrow trench or groove.

In the deep glabellar furrow injection therapies become more ineffective. Botox fails to be work well as the skin indentation is deep and muscle relaxation does not make much of a difference once it reaches this depth. Adding volume underneath the furrow by fillers or fat injections is also ineffective as the now V-shaped indentation resists pure pressure displacement outward.

In the deep V-shaped glabellar furrow one surgical strategy is release and interpositioning grafting. The furrow is initially released by small nick incisions at the top and bottom of it to fully separate the underlying muscles and release the skin. A soft tissue graft (in this case a muscle graft from a temporal reduction procedure being done) is then cut too longer than the length of the furrow.

A curved passer is used to go between the two incisions to make a wide underlying recipient bed. It is then used to grab the tissue graft and thread it through the pocket.

Once in place any graft excess is removed and the nick incisions closed with 6-0 plain sutures.  

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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