I have a horizontal glabellar crease between my eyes. What procedure can correct this and give me permanent results? (Photo)

Question

I have a horizontal Glabellar crease between my eyes above the bridge of my nose. I've had it my whole life and feel it's partly due to the fact I have a slight caveman forehead. I'm not interested in "Temporary" non surgical procedures such as Botox, Fillers, Laser. I'm more interested in longterm results through surgical procedures. I talked to one Plastic Surgeon about a "Brow Lift" but he only wanted to give me Botox. He stated the results I'm looking for wouldn't happen through a Brow lift.

Winfield Hartley, MD - Account Suspended · Answer

The only surgical option that may give you permanent results that I have seen work involves resection of the corregator and procerus muscles through an upper blepharoplasty incision.  It is a difficult operation with significant bruising and swelling and as such is not performed by many surgeons.  Check in your area to find someone with experience with this technique.  Best of luck.

Farhad Rafizadeh, MD · Answer

Relaxing the muscles in the area will definitely soften the crease but augmenting this area would probably be a more permanent solution. You have some options: Radiesse works well in that area and can be long lasting. This is probably the easiest option, but it needs to be done by an expert preferably with a blunt cannula. Fat grafting. should work as well but again same precautions apply here. Cartilage grafting would require a rhinoplasty approach and it would be more complicated. Your next and probably best option is an endoscopic muscle resection in the area and placement of a fat graft or cartilage graft directly in the crease. Good luck.

Manish H. Shah, MD, FACS · Answer

Hello jay.90,Thanks for your question.As you continue to lose bone as you age, that crease will eventually come back even if surgically corrected. This means that there is no such thing as a permanent improvement or correction.  The closest thing you can have done is a radix augmentation with an implant or with your own cartilage.  I prefer to use Medpor (ePTFE) implants or ear cartilage as my 2 first choices.The radix is the area of transition from the brow to the top of the nose, and it will crease in time for everyone. When you have more projection to your forehead, it can happen in young people like you also.This is a procedure that can be done in the office under local anesthesia using either an incision in the radix area, or via an incision inside the nose.Another secondary option would be to lift your brows up to tighten that skin and reduce the muscle function in the area that furrows your eyebrows.  This is a bigger undertaking and is usually done under general anesthesia in a surgery center.We would be happy to see you at our office in Cherry Creek for a consultation.Take care,Dr. Shah

Ross A. Clevens, MD, FACS · Answer

Endoscopic
Forehead ‘Muscleplasty’ is similar to endoscopic brow lifting, however, the
forehead and the brows are only minimally elevated or repositioned. Instead,
the underlying brow and forehead muscles are contoured with a laser to soften
the wrinkles, deep lines or creases that have formed. These lines are often
associated with a tired and angry look. This is essentially the surgical
equivalent of Botox, Xeomin and Dysport. The muscles are surgically weakened to
diminish the frown and brow lines just like chemical denervation with Botox,
Xeomin and Dysport. Whereas Injectable treatments last for three months, the
surgical approach lasts for many years.I suggest you consult a board certified facial plastic surgeon
to receive the highest quality knowledge, treatment, care and skill available.

A consultation provides you the opportunity to relay your
concerns and desired outcome to the surgeon while the surgeon can assess your
health profile and discuss his/her pertinent advice.

Michael J. Yaremchuk, MD (license resigned) · Answer

He is correct. It is unlikely that a browlift would efface
this transverse wrinkle. Furthermore, it would necessarily elevate your medial
brow. A bad look for anyone, especially males. Leave it alone.

William Portuese, MD · Answer

To accomplish the horizontal glabellar crease reduction, the radix can be augmented with the patient's own cartilage harvested from inside the nose. In addition, the procerus muscle And corrugator muscle should be softened and weakened as well as a slight lifting of the medial portion of the eyebrows with a brow lift.

Stacey Folk, MD · Answer

Dear Jay.90,There are a few options in treating your deep glabellar crease, and when making decisions about which is best, you may want to consider a combination of options for the best result. Your deep crease may be due in part to a deep radix (especially compared to your strong brow bone), brow ptosis or droop, and strong muscle contraction. If you perform a brow lift to improve this area you have to be sure you can easily conceal the scars (male hairline changes throughout life are more concerning), and like the difference in your appearance as it relates to your new brow position. Eyebrow position relays quite a bit of non-verbal communication through expression, and if the medial portion is strongly elevated you can look more worried, if the entire brow is too high you can look surprised, and if the outer aspect or tail is too high it can look more feminine. Too low of a brow position can look more serious or angry, so the lifting may be something you really like.During a brow lift the glabellar muscles are typically weakened but you may still benefit from botox because many people still have some muscle function after surgery. You likely will also need to build up volume in the deeper radix with a graft or filler.It is understandable that patients prefer a more definitive solution, but in some instances the best result is achieved with combination therapy.Best of luck,

Edward Farrior, MD · Answer

The deep horizontal crease at the root of the nose between the medial eyebrows can be improved permanently.  In order to achieve the most improvement the nasal radix needs to be elevated and the medial brow needs to be lifted.  The nasal radix, root of the nose, can be elevated with an alloplastic(symptomatic) or autologous(your own tissue) graft.  This will soften the transition from the forehead to the nose and reduce the Caveman appearance of the brow.  A browlift can also be performed and the corrugator muscle and procerus muscle can be weakened and order to prevent them from pulling the medial brow inferiorly again.  These procedures could be staged and based on the degree of improvement you get with an individual procedure you can choose to proceed or not proceed with additional surgery or you could perform both procedures at the same time.

Francis R. Palmer, III, MD (retired) · Answer

Hi, the issues here is that there are two separate muscles creating the wrinkles and folds.  The horizontal crease is a forehead muscle but the lower horizontal crease is from a nasal muscle.  These muscles can be transected which will result in a softening of the wrinkles.  The issue is how to best gain access to those muscles?  I suggest a consultation to discuss your best options.  Brow Lifts in men are ill advised as they require large scars in the hair line that can become noticeable with subsequent hair loss.  Botox can be done in a serial manner to effectively cause muscle hypertrophy and semi permanent softening of the wrinkles.  Hope this helps.

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