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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181cb649e
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Direct Excision of Glabellar Furrows: An Alternative Treatment for Severe Glabellar Rhytides

Tanna, Neil M.D., M.B.A.; Joshi, Arjun S. M.D.; Vira, Darshni M.D.; Lindsey, William H. M.D.

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Division of Otolaryngology–Head and Neck Surgery; George Washington University; Washington, D.C.(Tanna, Joshi, Lindsey)

Division of Head and Neck Surgery; David Geffen School of Medicine; University of California, Los Angeles; Los Angeles, Calif.(Vira)

Correspondence to Dr. Tanna Department of Surgery; George Washington University; 2475 Virginia Avenue NW, Apt. 907; Washington, D.C. 20037; ntanna@gwu.edu

Sir:

Treatment options for severe glabellar rhytides include brow lifts with open resection of the corrugator muscle, botulinum toxin type A (Botox; Allergan, Inc., Irvine, Calif.) injections, intradermal fillers, topical creams, and endoscopic resection of the corrugator muscle.1,2 For a select group of motivated patients with glabellar rhytides that are more severe than the potential postoperative scarring, we believe that the direct excision of severe glabellar furrows is an effective surgical alternative to traditional approaches. It offers the advantage of reduced downtime postoperatively, decreased price, and potential permanency.

This prospective study, conducted over a 4-year period, included 10 patients who met criteria for open or endoscopic treatment of severe glabellar rhytides. Each patient underwent direct excision of glabellar rhytides, with the incision length, method of handling skin and soft tissue, and time of surgery kept as similar as possible between patients. Patients underwent evaluation, along with photodocumentation, at 3 days, 1 week, 3 weeks, and 6 weeks postoperatively. Complications and revision rates were noted. Outcome measures included brow ptosis, incisional erythema, suture marks, suture extrusion, wound infections, hematoma, seroma, unacceptable scarring (hypertrophic scarring and scar unevenness), dehiscence, and numbness. Patient satisfaction was assessed during the 6-month postoperative visit.

In 10 patients, there were no cases of brow ptosis, infections, hematomas, seromas, or wound dehiscences observed. Two patients had suture extrusion, and one had mild hypertrophic scarring, requiring scar resurfacing. There were no cases of brow ptosis. All patients complained of numbness lasting for several weeks to months, and none reported numbness at the 6-month follow-up visit. At the 6-month follow-up visit, all patients reported being very satisfied with their results.

There are significant data to suggest that the endoscopic brow lift with corrugator resection is very effective.3,4 However, our experience has been that many surgeons remain cautious during endoscopic and open brow lifts because of the potential risk for damage to the supratrochlear neurovascular bundle. As a result, we have seen patients require multiple treatments (nonsurgical and surgical) for persistent glabellar frown lines (Fig. 1).

Fig. 1
Fig. 1
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Direct excision is an excellent alternative to other traditional procedures. The surgical effect is usually permanent after the initial treatment, and patients notice the results instantly (Figs. 1 and 2). Direct excision is not performed as frequently as other operations for glabellar furrowing, and for this reason, few data are currently available. Disadvantages of this procedure include minor scarring that is typically unnoticeable in most cases. Numbness can affect initial patient satisfaction in our study; however, all cases of numbness in this series of patients resolved within 6 months after surgery.

Fig. 2
Fig. 2
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Decreased postoperative downtime, decreased price, and potential permanency all are important reasons to consider direct excision as a useful and effective option for the treatment of glabellar furrows. We do not purport that direct excision should be a universal treatment but suggest that direct excision should be considered as a viable option for suitable patients. In our experience, the results are as effective as other approaches, and scarring is typically minimal, creating favorable results for patients with severe glabellar furrows.

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DISCLOSURE

The authors have no commercial or financial interests to disclose.

Neil Tanna, M.D., M.B.A.

Arjun S. Joshi, M.D.

Division of Otolaryngology–Head and Neck Surgery

George Washington University

Washington, D.C.

Darshni Vira, M.D.

Division of Head and Neck Surgery

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles, Calif.

William H. Lindsey, M.D.

Division of Otolaryngology–Head and Neck Surgery

George Washington University

Washington, D.C.

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REFERENCES

1. Frampton JE, Easthope SE. Botulinum toxin A (Botox Cosmetic): A review of its use in the treatment of glabellar frown lines. Am J Clin Dermatol. 2003;4:709–725.

2. Patel MP, Talmor M, Nolan WB. Botox and collagen for glabellar furrows: Advantages of combination therapy. Ann Plast Surg. 2004;52:442–447; discussion 447.

3. Matarasso A, Matarasso SL. Endoscopic surgical correction of glabellar creases. Dermatol Surg. 1995;21:695–700.

4. De Cordier BC, de la Torre JI, Al-Hakeem MS, et al. Endoscopic forehead lift: Review of technique, cases, and complications. Plast Reconstr Surg. 2002;110:1558–1568; discussion 1569–1570.

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