Robert S. Hamas, MD

Abstract. Certain patients subconsciously frown whenever concentrating or conversing. This hyperactivity of their corrugator muscles gives them an unattractive mean or angry look. Prominent glabellar frown lines eventually result from making this facial expression repeatedly. If such patients undergo an open coronal browlift, their corrugator muscles are resected routinely. However, patients who do not need or want a browlift seldom agree to a coronal incision just for access to their corrugators. To address this problem, the author devised an endoscopic operation to approach and resect the corrugators through three 5-mm hairline incisions. In this initial series, the subconscious tendency to frown when concentrating or conversing was reduced to about 20% of the preoperative level. This resulted in a more pleasant facial appearance.

Fig 1. The unbecoming frown made subconsciously by this 40 year old whenever she was in deep thought or listening intensely to someone.

Many patients are bothered by prominent glabellar frown lines. These vertical creases result from repeated contraction of the corrugator muscles with contributions from the overlying orbital portion of the orbicularis oculi muscles. While these lines are usually one of the stigmata of the aging face, they sometimes are seen in much younger patients who have hyperactive corrugator muscles. These patients have a subconscious tendency to make a frowning expression whenever they are concentrating or conversing. This facial expression is undesirable and unattractive because it makes them look mean or angry (Fig.1). Patients become aware of doing this when friends, family, and coworkers react to their expression and ask if something is wrong or why they are upset. Patients may express irritation at having to repeatedly reassure others that they are not in a bad mood. (A history of habitual frowning expressions may go back to childhood, with recollections of a parent admonishing them to quit frowning or even applying tape to the glabellar area at night.)

Patients may present seeking collagen injections to treat their glabellar lines. While that may camouflage them temporarily, it does not address the underlying cause: hyperactive corrugator muscles. If the patient had brow ptosis and was undergoing a brow lift, the corrugator muscles would be resected as a routine adjunctive procedure. Many young patients do not need or want their brows lifted and would not agree to a coronal incision just to access the corrugators. This situation is what led the author to devise an endoscopic approach to the corrugator muscles.

Presented in part at the Annual Meeting of the American Society for Aesthetic Plastic Surgery, Boston, 21 April 1992, and the Lipoplasty Society Forum for Innovative Plastic Surgery, Dallas, 15 April 1994.