Would forehead filler between brow ridges affect a prominent vein? (photos)

Question

I have protruding brow ridges with low volume in between which creates a vertical shadow on my forehead. I would have it filled but I'm worried about the vein that goes through this area. (Two questions: - Could filling between the brow ridges risk compressing on that vein and hinder blood flow? (assuming no intravascular injection) - If safe, could filling around and above the vein diminish its appearance? Any other treatment options would be worth mentioning

Alexander Rivkin, MD · Answer

Hello and thank you for your question.  You are right in assuming that it is dangerous to inject in that area as there is a risk for vascular compromise.  There is less of a risk when using a cannula, however it is still an area where many injectors treat cautiously. Adversely, the prominence of the brows, which can be either muscle or bone, are causing the depression seen in the middle.  Botox can be used to treat the frown muscles (corregator) and over time with continuous treatment, the muscle can atrophy and reduce the prominence, thus giving a smoother transition between brow and forehead.  It is best to be seen for an in-person consultation by an experienced injector who specializes in facial aesthetics.  Best of luck!

Jason Emer, MD · Answer

Botox can be used to improve this area. However, a combination approach with Botox and lasers, microneedling/prp and fillers may be needed to get the most improvement. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Jeffrey Jumaily, MD · Answer

IF you don’t like the bone contour over the brows then you have two options 1) fillers 2) Surgery. Fillers have the risk of intravascular injection but it should be very low if done well. Fillers won’t make the vein go away. You do have to maintain the fillers as they dissolve over time. For people who want permanent solution, I have always treated this with  bone contouring. You have an incision in the hair and the bone is shaved and set back so it’s a little smoother.Again it’s all about what your desired goals are. Schedule a consult with a forehead specialist to discuss the details. Best wishes

Monica Bonakdar, MD · Answer

Hi
there,
Thanks
for the picture and your clear explanation of your goals. 
Generally
in my practice, I would recommend a combination of a muscle relaxer like Botox
Cosmetic and a filler like one of the five from the Juvederm family of filler
that matches your skin texture. Once corrected, people will no longer
think that you are chronically angry and you will be more approachable!
It
sounds like you have done your research and understand that filler
injections carry varying risks depending on the area being injected.  Incidentally,
the area between the brows which in medical terminology is called the glabellar
area, is one of the more difficult areas to correct . Because it carries a
high risk for vascular accidents. 
I use
a vein finder, called Accuvein to accurately map the vessels that I need to
avoid. Even with the right tools, it takes years of experience to get this area
corrected safely. 
I
hope my answer helps you with your preliminary research. Once you are
ready to go forward, choose a highly experienced injector
who uses a vein finder and start with a consultation and a treatment plan.
Best
of luck to you, 
Dr B

Lawrence Janowski, MD · Answer

Yes, fillers can safely be injected in this area using a microcannula to avoid intravascular injection, and there is no concern about compression necrosis.  And, yes, sufficient filling of this frontal depression should diminish the appearance of the vein, though likely not eliminate it.

Shaun Patel, MD · Answer

I would start with Botox or Dysport instead of filler for this area. Treating the glabellar muscle complex between the eyes will reduce the appearance of these "ridges" you are seeing. There is a higher risk of vascular injury with regards to filler injection in the forehead and so it should only be done by an experienced injector.

Mehdi Sina, MD · Answer

Hi,The area you have highlighted is definitely a high risk area to inject. You may be able to achieve the aesthetic outcome you are looking for by softening the muscle under the brow with botox/dysport. Best,

Would forehead filler between brow ridges affect a prominent vein? (photos)

Answers (7)

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