Can Botox or Dysport cause a permanent dent to form in the muscles on my forehead? (Photos)

Thank you for sharing your question and photographs.  Although Botox does not make a permanent indentation in the face, it can cause muscle atrophy.  Combined with perhaps a side-sleeper this can create deeper lateral lines in the forehead.  If this is what has occurred I would stop Botox treatments until the muscle thickens and this should improve your result.  Talk to your injector as they know you, and your treatments, the best.  Hope this helps.

Thank you for your question, volume and contouring of the face and temples can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Implants or fat are alternatives. I recommend getting a formal evaluation with a facial sculpting expert to go over your desired results and recommendations. Best, Dr. Emer

I am not aware of botox causing permanent dentsc, in your case, after looking at the photo I suspect your dents may have something to do with the placement of the botox. I would advice you see an experienced injector and have a through examination.

Please take pictures while relaxed and then while animating to see the muscle movement. Botox will not cause depression but you can have depression at the border of the active and relaxed muscles. If there is dents while you relaxed, then fillers or fat grafting can help.

You do have some atrophy most likely from the injections and filler such as Radiesse will help the appearance and  no more Botox. See an experienced board certified dermatologist

Thank you for your pictures. It is hard to comment without a proper in-person evaluation. However, I have some patients that did have worsening of their lateral forehead wrinkles after Botox or Dysport. I suspect it is due in part to the loss of tonus of the forehead  muscle and being a side or stomach sleeper, creating mechanical lines and wrinkles. We saw great improvement in those lines by changing sleep position to back and the use of a forehead sleep band like SYLA. Dermal fillers can also be done afterward if necessary. I hope this help. All the best, Dr Michon

I would visit a reputable plastic surgeon near you. Do Not use botox for approximately 3 months and then have another evaluation. If the indent continues to appear, I would fill it out with some of your own fat. It should provide you with near permanent the natural result. Good luck for New York City

Thank you for your question and for sharing your photographs jengw3. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
If I had a patient with the concern described here I would want to know the dose used and the placement of the product. From the pictures it appears that there is a bulge in the corrugator muscles. It is not stated whether the patient is frowning in this photograph. I would want to see pictures with a neutral expression and frowning to see if the bulge is from this muscle as I suspect. I also suspect that when the forehead was treated, only the horizontal lines on the upper forehead were treated without treating the glabella. In this case the muscles in the glabella may act unopposed and become stronger and lead to a bulge. Above the bulge is a depression that is secondary to the bulge. If this is the case, it can easily be treated by placing product in the glabella.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!