Corrugator excision? Botox isn’t providing relief from thick, prominent glabellar muscles. (photo)

Question

I have very thick glabellar skin & what seems to be excess tissue or muscle. Botox works by preventing me to make a forrow but isn’t providing any relief to “flatten” out my thick muscles. Even with Botox, I still have these muscle bulges that make me look angry even when I’m not forrowing. Is this excess fat? Excess skin? Large muscles? What would improve this? Brow lift? Corrugator excision? Again, Botox does work by paralyzing these muscles, but the muscle bulkiness/mass/deep furrows remain.

Aditya Sood, MD, MBA, FACS · Answer

Great question! It is hard to give you a definite answer without knowing your history (for example how many times or how long ago you have had neurotoxin injected). You seem to have some corrugator hypertrophy vs. thickness or irregularity of your frontal bar (bone). If it is your muscles, sometimes botox used over time can cause enough atrophy of the muscle to help correct this, but a corrugator resection (surgery) may be a better option if this is what you are specifically looking to correct. If it is an irregularity not caused by muscle, then having filler injected into the glabella can help smoothen the irregularity. Best of Luck!

Vito C. Quatela, MD · Answer

You would definitely benefit from an in-person consultation and physical exam as it’s tough to say without being able to examine and feel this area. However, we frequently perform corrugator excision via an endoscopic technique and it is typically very well tolerated and achieves good results. Best of luck!

Ralph M. Rosato, MD · Answer

Excision of the muscle should improve the appearance of your frown lines. This can be done thru an eyelid incision of from the hair with a scope.  You need to find a Board certified plastic surgeon and have an examination to determine you best option. Good luck.

Nicholas S. Karter, MD · Answer

This is a very interesting question. In general, Botox injections over a long enough period of time do cause some degree of muscle atrophy. There are interesting studies looking at muscle density on MRI after repeat Botox injections that illustrate this. A good question would be how long or how often have you been doing injections? Also, it appears from the photos provided that your corrugator muscle is quite a bit more vertically oriented than average. Usually the muscle extends out laterally with the brow, but in some cases (I believe you may be one) the muscle takes a more vertical orientation. It is possible that if the injections have been done in the "normal pattern" they may be missing the distal end of the muscle where it interdigitates with the skin, but treating the medial portion of the muscle which lays deeper. It is possible that this is contributing to the bulge effect you are seeing. Certainly the muscles can be divided in a brow lift, but care must be taken. It is important to keep in mind that there could be unwanted volume loss from this (often corrected with a graft at the time of transection) and return of muscle activity from scarring connecting the transected muscle stumps.
There are a lot of options available to address this problem. I would suggest having a consultation with a surgeon in your area and discussing them in more detail. The right choice for you will be which one can achieve your goals within your acceptable risk/downtime/costs/etc. I hope this helped, good luck!!

William Portuese, MD · Answer

Corrugated or excision is usually performed as a component of a brow lift procedure when lifting low set eyebrows. The  corrugator is excised, softened and divided to reduce that scowling effect like Botox. For many before-and-after  brow lift examples with corrugator excision, please see the link and the video below.

Corrugator excision? Botox isn’t providing relief from thick, prominent glabellar muscles. (photo)

Answers (5)

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