Corrugator supercilii muscle terminal nerve ablation using a novel thread technique for the treatment of hyperdynamic vertical glabellar furrows.

Background: A novel percutaneous corrugator supercilii muscle terminal nerve CSMTN ablation technique is proposed for the treatment of hyperdynamic vertical glabellar furrows (HVGF).

Technique: Two surgical marks are placed on each eyebrow. One is placed at the level of the lateral canthus and the second at the outer border of the limbus. At each of the four marks, the following steps are carried out: (1) a guiding needle is used to punch the frontal skin at 3 mm above the eyebrow (orifice A) and will then travel deeply at the level of the supraperiostium and emerge outside the skin 3 mm below the eyebrow (orifice B) at the palpebral skin; (2) the needle is then reentered exactly at orifice B and will travel underneath the skin at a more superficial level in the subcutaneous layer and then emerge outside exactly at orifice A. Both ends of the thread are gently pulled in a sawing motion with counter tension until no more resistance is felt from the anatomical structures involved, and then the loops of thread are withdrawn from orifice A.

Results: Forty-seven subjects underwent bilateral CSMTN ablation. In the first 10 cases, the authors performed only one neurotomy per eye and observed a 50 percent HVGF recurrence rate. Then, the authors chose to perform two neurotomies per side and had a three percent recurrence rate (1/37) with a high degree of patient satisfaction. Major complications such as deforming hematomas, eyelid ptosis, abscess, scar formation or adhesions were not observed during follow up.

Conclusion: This novel technique may represent a simple and permanent solution for HVGF.