Can Supraorbital Nerve Decompression and Brow Bone Reduction Be Done At The Same Time?
Q: Dr. Eppley, I am a chronic migraine sufferer. I am 30-years old and have tried all kinds of pills, nasal sprays, powders, self-injectables, and tablets for my migraines. I specifically get pain in the frontal area. I do believe that the trigger point is either the frontal or nasal. The pain is behind the eyeballs, on the eyebrows, and the forehead. I am aware that insurance doesn’t cover surgery, although it does in my state of where I reside. It is called Nerve Decompression surgery. I do have some questions from Dr. Eppley if possible:
- Specific treatment for this involves decompressing the supraorbital AND supratrochlear nerves in the glabellar area by resecting the corrugator and depressor supercilia muscles using a minimally invasive endoscopic approach similar to that used for a cosmetic forehead lift. Supraorbital and supratrochlear nerves are decompressed……..
Your website states that a brow bone reduction could help this. I think I am only a candidate for Type 1. Do you believe that shaving the bone could help decompress the nerves? (incision would be via frontal hairline)
- Can you combine this with a slight orbital rim shave?
- Have any of your patients with frontal pain who had surgery had any success? Are they completely migraine free or reduced?
- Dr. Bahman Guyuron started doing forehead lifts/brow lifts and many of his patients had little to no migraines. He also founded the migraine surgery society.
I know this sounds crazy but I do believe this pain comes from the anatomy of my bone structure. I do have masculine features.
A :Thank you for your inquiry and sending your imaging to which I can say:
1) You have very wide open orbits and an exit of the supraorbital nerves that shows no inferior bony containment at the medial inferior supraorbital rim. Thus specific bony decompression of the supraorbital nerve does not seem to be needed as there is no obvious bony constriction of the nerve)
2) You have a perfectly straight septum with no inferior turbinate impingement on it, thus I see no evidence for a nasal basis for your migraines.
3) This brings it back to whether standard release of the supraorbital nerves with muscle resection would be of benefit. No matter what is written about the success rate of the procedure all patients must know that it is unpredictable. While many patients get relief some do not. (In the short term everyone does because of the nerve numbness) It would be fair to say that improvement means a reduction in their symptoms. Do some patients become completely symptom free…rarely.
4) The two methods to perform supraorbital nerve decompression and muscle release is either through a superior endoscopic technique or through an inferior upper eyelid approach. Each method has its advantages and disadvantages. Because you don’t need bone removed below the supraorbital foramen this makes the endoscopic technique a viable options.
5) Shaving the orbital rims for their aesthetic benefits has to be done through a frontal hairline incision not an endoscopic technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
North Meridian Medical Building
12188-A North Meridian St.
Carmel, IN 46032
Phone: (317) 706-4444
WhatsApp: (317) 941-8237