Beyond Botox

Transpalpebral Corrugator Resection

You may not know what they are called, but you know what they do. Corrugator muscles are the culprits causing the “11’s” between your eyebrows. Botox became a household name by virtue of paralyzing these muscles and smoothing out frown lines. What if you could trade your quarterly visit for Botox for one procedure that would permanently neutralize these muscles?

Though not a widely discussed option, a Transpalpebral Corrugator Resection erases the frown lines, opens the eyelid and reshapes the brow. Where Botox temporarily stops muscle activity, this intervention surgically removes the muscle and releases ligaments that restrain or control the eyebrow. Like strings of a hot air balloon, it elevates the eyebrow returning the brow to a more youthful height and shape. Through an incision made in the crease of the upper eyelid, approximately 90% of the muscle is removed with some intentionally left behind for expression. Since the corrugator muscles can overpower the brow, pulling it down into an unattractive arch, the removal of these muscles delivers the happy byproduct of a browlift.

Procedure Snapshot:

  • Part(s) of the body treated by this method: orbit of eye area around eye and eyebrows
  • Time for procedure: one hour
  • Adjunct procedures that may be considered: hairline lowering
  • Anesthetic: Local sedation if done exclusive of any other procedure or general anesthesia if done as part of a combination of procedures
  • Number of sessions required: one
  • Downtime: one week
  • Complications/Risks: bruising and temporary forehead numbness
  • How long results last: indefinitely—Botox recommended every 1-2 years.
  • Cost $/$$/$$$: $ Two year return on investment when compared with Botox

One on one with Dr. Kornstein:

If you look at your cheeks as being the lower frame of the eyes, the brows serve as an important upper frame of the eye. Just like a deflated cheek can signal aging, the low or misshapen brow can be a non verbal cue of an unaesthetic or aged face.

Four to five years ago, Botox was the newest non surgical cosmetic intervention and an exciting addition to our anti-aging arsenal. Ideally, after leaving your aesthetic practitioner the position of your eyebrows would be a bit higher and your wrinkles were smoothed. If you multiply the cost of Botox on an annual basis and take the risks into account you can see the benefit of the transpalpebral corrugator resection. This special procedure is done once and accomplishes everything Botox does—only it is permanent. In addition to retiring the muscles it also results in a welcome side effect—the elevation and reshaping of the eyebrow.

This procedure demands a deep knowledge of anatomy and meticulous skill and precision because it is performed in such a small space. It’s technically challenging to get right while avoiding complications such as asymmetry and nerve damage. Some surgeons don’t offer it because of the steep learning curve, but once mastered it is reproducible. In the right hands it is a very low risk procedure. Botox is not without its own issues. In fact, because of its overall popularity, patients are seduced into a false sense of security. Botox is not risk free, nor is it cheap.

Asymmetries, bruising and a ptotic (drooping) eyelid are quite common. In contradistinction, the benefits of the transpalpebral corrugator resection offer a better, long lasting result with little risk. When you figure the money and time you are saving in bypassing regular Botox visits, you realize that money might be better spent on other aspects of your appearance that might not have been in the budget.


It’s always best to schedule a complimentary consultation to receive the most specific information for your goals.