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Original Investigation
May 2, 2019

Association of Corrugator Supercilii and Procerus Myectomy With Endoscopic Browlift Outcomes

Author Affiliations
  • 1Mangat, Holzapfel, and Lied Plastic Surgery, Cincinnati, Ohio
  • 2Jacobs School of Medicine and Biomedical Sciences, Department of Otolaryngology, University at Buffalo, Buffalo, New York
JAMA Facial Plast Surg. 2019;21(5):375-380. doi:10.1001/jamafacial.2018.2084
Key Points

Question  Is the addition of corrugator and procerus myectomy to browlift procedures associated with improved outcomes?

Findings  In this comparative cohort study of 23 patients who underwent browlift surgery with or without corrugator and procerus myectomy, the browlifts with muscle resection were associated with superior glabellar wrinkle reduction compared with the browlifts without muscle resection.

Meaning  In browlift procedures, the incorporation of corrugator and procerus myectomy may result in improved aesthetic outcomes in the glabellar region.

Abstract

Importance  Glabellar wrinkling is a critical component of upper facial aging.

Objective  To compare the long-term outcomes on the wrinkle lines of the glabella and forehead following browlifts with vs without corrugator and procerus muscle resection.

Design, Setting, and Participants  A prospective cohort comparative trial was conducted of 23 patients who underwent browlift procedures by a single surgeon at a single institution (16 with glabellar muscle resection and 7 without muscle resection) between May 1, 2016, and July 1, 2017. All analysis took place between May 1, 2016, and May 14, 2018. The mean follow-up period was 16 months (range, 12-21 months). Sixteen of the 23 patients underwent a browlift with muscle resection procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Four of the 23 patients underwent browlifts only, and 19 had browlifts with other procedures. Seven of the 23 patients had browlift procedures without muscle resection and were designated as controls.

Interventions  Endoscopic browlift surgery was performed either with procerus and corrugator muscle resection or without muscle resection.

Main Outcomes and Measures  Neutral gaze and dynamic photographs of the upper face obtained preoperatively and after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 2 physicians not affiliated with the study team using a modified Fitzpatrick Wrinkle Assessment score (FWA; from 0 [no wrinkling] to 5 [deep wrinkling with redundant skin]).

Results  The 23 study patients had a mean age of 60 years (range, 48-74 years); 21 were women, and 2 were men. There was a significant difference between the myectomy and control groups in the 12-month postoperative improvement in dynamic glabellar FWA scores (2.56 vs 1.07, P = .01). There was a difference between the myectomy and control groups in the improvements in resting glabellar FWA scores at 12-month follow-up, but it did not reach statistical significance (1.28 vs 1.00, P = .38). The 12-month postoperative improvements in dynamic (1.19 vs 1.29, P = .86) and resting forehead (1.0 vs 1.1, P = .70) FWA scores were not significantly different.

Conclusions and Relevance  In this study, the use of procerus and corrugator myectomy techniques appeared to achieve a superior long-term reduction in glabellar wrinkles vs forehead rejuvenation techniques without muscle resection.

Level of Evidence  3.

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