Percutaneous Selective Radiofrequency Nerve Ablation for Glabellar Frown Lines

Abstract

The dynamic muscles of the glabellar region can be overactive, giving patients a "scowling" look and making them appear angry, worried, or stressed. The authors describe percutaneous selective nerve ablation, a minimally-invasive procedure for treatment of glabellar frown lines, and report results from a series of patients treated with the technique. From November 2007 to December 2009, 27 patients (22 women and five men) underwent percutaneous selective nerve ablation to improve glabellar frown lines. Initially, the surface pathway of the nerve to the corrugator supercilii and procerus was checked with a peripheral nerve stimulator. For percutaneous localization, a 22-gauge monopolar electrode was introduced into the lateral brow and cheek skin without incision. Short electrical stimulation (0.3-0.5 mA) was delivered to identify the proper lesion sites. Synchronous contraction of corrugator supercilii was elicited and radiofrequency nerve ablation performed (85°C, 70 seconds). In all patients, the frontal branch of the facial nerve and angular nerve were treated bilaterally. The improvement was evaluated with the Wrinkle Assessment Scale. Mean patient age was 54.5 years, and mean follow-up time was 18 months (range, 12-26 months). One patient had superficial second-degree burns to the brow skin, which healed with conservative treatment. Two patients had temporary paresthesia that completely resolved in a few weeks without sequelae. The Wrinkle Assessment Scale indicated a statistically significant improvement in the glabellar frown lines (preoperative vs postoperative mean, 3.7 vs 1.8; P < .05). Although long-term studies are necessary to determine the ideal amount of energy delivery for maximum efficacy and time for treatment of glabellar frown lines, the study lends support for the safety and efficacy of percutaneous selective nerve ablation.