Avulsion of the Corrugator Supercilii Muscle through a Closed Rhinoplasty Approach

Abstract

Sir: Patients presenting for rhinoplasty are generally young and do not need standard procedures for elimination of glabellar skin furrowing. Treatment of muscles responsible for frowning (corrugator supercilii, procerus, and depressor supercilii) through routine rhinoplasty approaches can be the most ideal approach for reduction, or prevention, of glabellar skin furrowing in these patients. Avulsion of corrugator supercilii and procerus muscles through a closed rhinoplasty approach was initially performed by the first author (A.J.K.-H.) on patients complaining of frown lines. It was performed by continuing subperiosteal dissection of nasal bones over the frontal bone up to 25 mm superior to the nasion and up to 16 mm lateral to the midline on each side. Since 2004, it has been performed on all patients undergoing closed rhinoplasty because of its feasibility, excellent results, and satisfaction of patients. During a 3-year period, the severity of frown lines of 250 patients was rated before surgery and at the follow-up visit 1 year after the operation. Rating was performed on a scale from 1 to 5 by the patient and by the second and third authors, with 5 being the most severe. Fifty-four men and 196 women were studied. The mean age was 24.52 ± 3.836 years (range, 18 to 36 years). The mean preoperative and postoperative scales of severity of frown lines are listed in Table 1. The mean scale was decreased significantly (by 0.6454) after the operation (t = 17.351, df = 249, p < 0.001) (Fig. 1). In the postoperative period, nearly all patients had some degree of hematoma in the glabellar region that was resolved by 2 weeks. There was no ecchymosis, no depression in the area of avulsion, and no dyskinesia of the muscles.Table 1: Mean Preoperative and Postoperative Scales of Severity of Frown LinesFig. 1.: (Above) Preoperative and (below) postoperative views of frown lines.In the study by Janis et al.,1 the most lateral and superior extent of the origin of the corrugator muscle was 14.0 ± 2.8 mm and 18.7 ± 2.42 mm from the nasion, respectively. Miller et al.2 demonstrated that all supratrochlear branches are located more than 1.6 cm from the midline. Thus, our extent of dissection had no risk of nerve injury and avulsed most of the origin fibers. The transpalpebral approach to the corrugator supercilii and procerus muscles has become a standard procedure for the treatment of glabellar frown lines after its description by Knize3 and Guyuron et al.4 Although complete resection of the corrugator muscle is advocated for a long-lasting and complete improvement in frown lines, its weakening through avulsion of its origin can be all that is needed in young rhinoplasty patients. Kalantar-Hormozi and Beiraghi-Toosi5 have proposed “rhinometry” for outcome assessment after rhinoplasty using actual measurements of the nose, but an objective yet simple and practical method for evaluating frown lines is not available. We used a scaling method similar to what Guyuron et al.4 used for evaluation of results of corrugator supercilii muscle resection through blepharoplasty incision. This method demonstrated a significant decrease of the scale of severity of frown lines following the operation. Avulsion of corrugator supercilii and procerus muscles through a closed rhinoplasty approach is a simple and valuable adjunct to rhinoplasty for treatment of minimal frown lines or, potentially, prevention of their progression. ACKNOWLEDGMENT The authors gratefully acknowledge the invaluable assistance of Alireza Chitsazan in taking photographs and managing photographic analyses. Abdoljalil Kalantar-Hormozi, M.D. Arash Beiraghi-Toosi, M.D. Elham Azarnoosh, M.D. 15 Khordad Hospital Tehran, Iran