Glabellar furrows - what surgical options will improve this? (Photo)

Question

Female, 53. I have very pronounced furrows in the glabellar region. Botox has very little effect. I’ve tried fillers but this added unwanted bulk and volume to the area. I’ve been told a brow lift wouldn’t help. Is there any other surgical option? I’m considering corrugator muscle excision and fat grafting or an implant. Are these suitable possibilities?

Kyle Kimura, MD · Answer

Thank you for your question and photo. 
This is a really tough question. Anatomically, you develop those vertical creases because of action of the corrugator muscles. The photo you provided, however looks to show those creases are present at rest (unless I am mistaken in interpretting the photo). Botox will typically best treat dynamic rhytids, or wrinkles that appear with movement. They can sometimes lessen the static rhytids, ie the creases at rest, however that can take some time. 
I agree a browlift would not make a difference as this looks to change the position of the brows themseleves, but typically doesn't have long term effect on these rhytids. And I feel excision of the muscle may be a bit of an extreme measure and could potentially lead to worse apperance of the area. 
Another option would be to see if you are a candidate for a deeper peel or laser resurfacing to soften these lines. 
Hope this helps and I wish you the best of luck!Kyle Kimura, MD

Gregory S. Keller, MD, FACS · Answer

A consultation will be necessary, but an endoscopic forehead procedure, done well with a good "release" of the muscles, can diminish the frown lines and move the brows into an advantageous position.

Gary M. Horndeski, MD · Answer

Unfortunately, the photograph does not show the whole forehead. However, a brow lift can be done to dissect down to the eyebrows. The eyebrows are below the orbital rim and they should be at or above the level of the orbital rim.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Nk Park, MD · Answer

Hi, I’m Dr. Park from Noonopi Plastic Surgery in Korea.
In my experience, an endoscopic brow lift alone is usually sufficient.
During the endoscopic brow lift, the corrugator muscles are excised internally, so there’s no need for an additional incision near the eyebrows&mdash;which could potentially leave visible scars.
I would not recommend fat grafting or implants in the glabellar area, as the skin in this region is quite thin and such additions can appear unnatural or bulky.

Cengizhan Ekizceli, MD · Answer

Thank you for your question. When neuromodulators and fillers don’t provide satisfactory results for deep glabellar furrows, surgical options like corrugator muscle excision can be highly effective, especially if your wrinkles are dynamic and muscle-driven.
Fat grafting is often preferred over synthetic implants due to its natural integration and lower risk of complications, though careful placement is key to avoid over-bulking. A direct browlift or glabellar skin excision may also be considered in select cases.
A personalized assessment is essential to determine the best approach based on skin thickness, muscle activity, and wrinkle depth. You’re on the right path by exploring these advanced options.

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