Is there anything that can be done about a wide, vertical forehead indentation? (Photo)

Question

Somewhat recently, I have developed this indentation on my forehead. I've lived through great stress over the past couple of months. I must see a clinician about my hormone levels first. Still, is it possible that I have somehow over-frowned and caused the two "frontalis" muscles, in their over-excitement, to create this indent in between them? If so, can relaxing cause them to revert back to their original, smoothened position?

Zoran Potparic, MD · Answer

Without clinical exam it is impossible to evaluate the nature and cause of this deformity. It may be related to soft tissue loss in central forehead;  linear scleroderma (coup de sabre deformity) may be the cause? This could be corrected with injection of soft tissue filler, fat graft, dermal graft or matrix once the cause of condition is identified.A consultation with a board certified plastic surgeon for detailed clinical evaluation should be your first step. Good luck.

W. John Bull, MD · Answer

It is hard to tell the cause based on this photo, but I have used Botox( or another neurotoxin such as Xeomin) to soften the muscles which in time will decrease the thickness of the muscles and make that part of the forehead more even. If this is the cause, that will work. If there is a separation between the muscles- which occurs naturally or even a relative loss of volume in this area or a bony depression, a filler would be the answer. These are safe to use in this location as well and I have done several with good results, but if Botox works I would stick (no pun intended) with that rather than using the fillers. Of course sometimes both are needed. If you find that you require many fillers over time a fat transfer might be a better long term solution.

Nicolette Picerno, MD · Answer

Dear Tyler,Although it is difficult to see in your photo, that indentation may actually be a bony depression, present to some extant or another in all humans. In some people it can become very unsightly. I have had good success with hyaluronic acid fillers, such as Restylane or Juvederm, in this area.  Another bonus is that this type of filler generally lasts a very long time in that location.  The recent stress you were under, or even simple aging,  may have increased your hormone, cortisol, which when elevated can lead to breakdown of elastic fibers and loss of subcutaneous fat. that may be why you are seeing these lines now and not before. Good luck in your search for a solution!

Benjamin C. Paul, MD · Answer

Thank you for your question. Though it would be best to evaluate you in person before recommending treatment, as a general guide I would first consider trying to use botox to soften the frontalis as well as the corregator muscles. This may soften ridges if they are from muscle contraction/hypertrophy. This is very safe. If the ridges persist after botox, proceed to using fillers along the bone to fill depression.  A thicker filler may be better and longer lasting in this location. Use of a blunt-tip canula can allow for feathering of the filler with a reduction in the risk of intravascular injection, which can be devastating. If the ridges are bony, a permanent solution would be to endoscopically view the ridges via ports in the hairline with the introduction of camera. With camera visualization, the surgeon could then file them down with a diamond burr or rasp.  Best of luck.Dr. P

Is there anything that can be done about a wide, vertical forehead indentation? (Photo)

Answers (4)

Answer: Treating a large vertical midline forehead depression

Answer: Treating a large vertical midline forehead depression

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Is there anything that can be done about a wide, vertical forehead indentation? (Photo)

Answers (4)

Answer: Treating a large vertical midline forehead depression

Answer: Treating a large vertical midline forehead depression

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Everything you need to know about Brow Lift

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