Why Do I Have an Indentation in Forehead After Botox?

There is an area of fixation of the tissues around the deep bransch of the supraorbital nerve where patients often develop a crease as they age. The botox may be "unveiling" the early tendency for this.

Hi lajolla.  If the indentation was a result of the Botox injection, it should be fairly simple to correct it.  It's possible that the outer forehead muscles were not treated well enough and are causing this indentation because the rest of the forehead is relaxed and that area is not.

Best bet is to return to your injector and take a look at your before and after pictures.  This always helps.

Thanks for the picture! Looks like the line has been created between the interface of treated and non-treated frontalis muscle....easier to differentiate in person. Return to your physician injector as he/she may need to address with additional application of Botox to the area.

Good luck and keep us posted!

Dr. C

johnconnorsmd.com

I am not convinced that we know of the reason for this diagonal line to form. your photograph appears to show that the middle forehead is slightly puffier than the outer side of the forehead. Your line is a very sharp line as if a shelf is formed by the puffy or hanging muscle slab in the middle forehead lying against the outer forehead. Possibly, the middle forehead is relaxed from the botox causing it to sag a little because it can't elevate from the botox effect and it lies against the remaining active outer forehead that is less sagging or bulky because it is active. Further treatment in the ouer forehead may help this. It could be that coincidentally, you have developed a sleep crease from lying on your left side when you sleep pushing the outer forehead skin up against the immobile Botox-affected middle forehead. Either way, it should not be permanent.

Botox changes the dynamics of brow function.  There are essentially 2 groups of muscles in your brow.  The elevators (frontalis) and depressors (corrugators, and procerus).  When the depressors are treated to remedy glabellar furrow (the "eleven"), the frontalis remains active.  The FDA has approved botox for the glabellar furrow in 2002.  It has since gained broad acceptance among physicians for off-label uses such as crow's feet, forehead wrinkles, platysmal banding, migraines, etc.  The furrow that you have now may be due to the residual activity of surrounding muscles that have remained active while the depressors have been weakened or paralyzed by botox.  See your doctor.  Don't be afraid to address your concern.  Additional botox in the non-treated muscle may remedy this issue.  Good luck!  You could also just wait it out, but it may take 4 months to resolve.

BOTOX itself will not cause an indentation. Botox is a muscle relaxer. However, if certain muscles relax and other muscles are not injected, those active muscles may be working harder and become more pronounced looking. You may have what appears to be a hole but is a depression area between a weakened muscle and a more active muscle. It will go away as the BOTOX wears off. You may also treat it by adding BOTOX to the muscle that is over worked. Just keep in mind that any kind of contra-irregularity in the forehead in regard to BOTOX is temporary and is a result of the way the muscles are working.

This is why Botox is an art and not a cookie cutter. Sometimes Botox treatments weaken some muscles and reveal the unsual muscle patterns underlying the area that might be unexpected. It's always a better idea to start with new treatments conservatively and then increase here and there to avoid unwanted outcomes. Once you have an established successful pattern of Botox treatments with your doctor, then you know what works for you.

This is fixable by seeing a careful board-certified dermatologist or plastic surgeon who understands the underlying complex facial anatomy for an additional few units of Botox this time around, and different placement next time.

This is a rare response to botox or dysport. The frontalis muscle is the main muscle in the area but there are many muscles . There are two potential solutions: one go back to your doctor to inject a little more to deactivate the muscle or to wait until it wears off. Most patients would prefer immediate treatment.

Addressing your concern with your injecting physician,should be the first thing you do. It looks as if a small amout of neurotoxin in the active muscles that are creating the line would help soften it.

Without examining you in person, I would guess that that line is due to some residual frontalis muscle activity. If so, this can be treated easily with a small amount of Botox placed in this area. I would go back to your treating physician to discuss this.