Can forehead botox cause an indentation on the hairline? (Photo)

Question

I have been getting botox on my forehead for wrinkles for over 10 years. I have noticed an indentation of my forehead at the hairline . Does this reflect poor placement of botox on my forehead or can this happen with any injector, even if they are very skilled? I get botox less frequently, around every 7-8 months. Should I cut down on the frequency?

Behnoush Zarrini, MD · Answer

Based on your photo, I don't see anything that suggests poor Botox placement. Botox relaxes muscle, but it does not dissolve bone or permanently thin the tissues of the forehead. A persistent indentation at the hairline is not a typical long-term side effect, especially if you're only receiving treatment every 7 to 8 months.In many cases, these contour changes are related to your natural forehead anatomy or age-related changes in the soft tissues rather than the Botox itself. I would not reduce the frequency of your treatments based on this finding alone. Instead, have your injector examine the area in person and compare it with older photos to determine whether this contour has always been present or has changed over time.I would be surprised if this were caused solely by Botox or poor injection technique.

Anna Chacon, MD, FAAD · Answer

I can understand why this would concern you, especially after receiving Botox consistently for many years.

The short answer is yes, it's possible, although it's not very common. Botox works by relaxing muscles, and over time, muscles that are repeatedly treated can become smaller (atrophy) from reduced activity. If the frontalis muscle near the hairline has gradually thinned over years of treatment, it could contribute to a subtle indentation in that area. This isn't necessarily a sign that anything was done incorrectly.

That said, Botox isn't the only possible explanation. Changes in the forehead over time can also be related to natural aging, loss of fat under the skin, changes in bone structure, weight fluctuations, or simply becoming more aware of facial contours. In many cases, it's a combination of these factors rather than the Botox alone.

Looking at your treatment history, receiving Botox every 7–8 months is actually less frequent than many people, who are treated every 3–4 months. Because of that, your injection schedule by itself doesn't suggest overuse.

As for whether this reflects poor injection technique, not necessarily. A well-trained injector carefully balances the forehead muscles to preserve a natural appearance, but even with excellent technique, long-term muscle relaxation can occasionally lead to mild changes in muscle bulk. If the injections have consistently been placed very high on the forehead near the hairline, that could contribute, but it's impossible to say based on a photo alone.

If the indentation is truly due to decreased muscle volume, simply spacing your treatments out even further may not completely reverse it. The frontalis muscle can regain some activity when Botox wears off, but the degree of recovery varies from person to person. Future treatments can often be adjusted by modifying the dose or avoiding repeated injections in the same exact areas if maintaining muscle bulk is a priority.

Overall, I wouldn't assume this means your injections were done improperly. Given your relatively infrequent treatment schedule, it's more likely that you're seeing a combination of long-term muscle changes and the natural aging process rather than a complication from poor placement.

Yasemin Aydinli, MD · Answer

Botulinum toxin relaxes muscle but does not dissolve bone or fat, so a true indentation at the hairline is more likely temporalis/frontalis muscle thinning from long-term relaxation, age-related bony remodeling, or fat atrophy &mdash; occasionally all three. This can occur even with skilled injectors after a decade of treatment. A small amount of filler can camouflage the depression if it bothers you, and spacing treatments further apart may limit progression.

Can forehead botox cause an indentation on the hairline? (Photo)

Answers (3)

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