Transpalpebral approach to the corrugator supercilii and procerus muscles

The most effective method for treating glabellar area skin contour irregularities produced by hyperactive corrugator supercilii and/or procerus muscles is resection of the former and at least transection of the latter. The usual surgical approach is a coronal incision, which produces recognized sequelae of scalp or prefrontal hairline scarring and scalp dysesthesia; potential complications include injury to the frontal branch of the facial nerve, postoperative alopecia, and excessive recession of the frontal hairline. Hyperactive corrugator supercilii muscles may be excised and procerus muscles transected without a coronal incision. These muscles can be treated through an upper blepharoplasty incision without compromise to the blepharoplasty procedure. A transpalpebral technique as performed on 40 patients followed 6 to 24 months is described, and the cadaver and nerve block studies upon which this technique is based are discussed. The postoperative cosmetic improvement of the glabellar area is comparable in appearance with that achieved from a coronal incision approach.