What can be done for this vertical dent in my forehead, it can only be seen in certain lights. (Photo)

Question

Would Botox sort out this line? It can only be seen in certain lights and in certain photos.

Brock Ridenour, MD · Answer

Botox treats lines or wrinkles of facial expression in the skin by relaxing the muscles that cause them.  What you have described is a dent or contour depression of your central forehead. Botox would not be an effective treatment for this condition.  Vertical depressions in the forehead may be caused by the shape of the frontal bone, trauma, low body fat, or much rarer conditions such as linear scleroderma. Sometimes pressure from a large central vein in the forehead can result in a loss of fat  over time due to coughing, laughter, sneezing or exercise.  In pale skin individuals such as yourself,  you can often see blue-tinged veins under the skin. The dark color may lend the appearance of a dent or depression in certain lighting. If you do have a contour depression it can be treated with a hyaluronic acid filler or fat injection. You should consult with an experienced physician injector, familiar with the vascular anatomy in this region, as injections in this area carry a higher risk of serious complication. My best.

Ali Sajjadian, MD, FACS · Answer

Thanks Keirhardie27 for your question! It’s completely understandable that this is bugging you, especially when it plays "hide and seek" depending on the lighting. Whether Botox will work depends on why the line is there.
The line I see is a subtle, vertical shadow right in the center of your forehead. Because your face is relaxed in this photo, this looks less like a "frown line" (which usually appears lower, between the eyebrows) and more like a slight volume indentation or a natural anatomical variation. Since this line is visible while your face is resting, Botox alone may not completely "sort it out." Botox works by relaxing the muscle movement that creates a wrinkle. If the muscle is already relaxed and you can still see the dent, the Botox won't have much to "relax." However, if you find that you subconsciously contract your brows or scowl throughout the day, Botox could prevent the line from getting deeper over time. 
Some people have a natural, slight gap between the two halves of the forehead muscle (the frontalis). This can create a vertical dip right in the center. If you are a side or stomach sleeper, your forehead can "fold" against the pillow, which eventually creates a static line.
You should see an Expert physician who can examine you and your vertical line and see which type of line you have on your forehead. 
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Anna Petropoulos, MD, FRCS · Answer

Botox works by relaxing facial muscles to reduce lines and wrinkles caused by expressions. However, it isn't effective for treating dents or depressions in the central forehead. These indentations may result from factors like injuries or underlying vasculature or bone structure. In people with lighter skin, visible veins might make these areas appear darker or sunken. If you have a noticeable depression, options like hyaluronic acid fillers or fat injections might help. It's crucial to seek advice from a skilled physician who is knowledgeable about the vascular anatomy of this region, as injections in this area carry increased risks. Best of luck! Genie Alexander, RN BSN for Dr. Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

Misbah Khan MD, FAAD, FACMS · Answer

you have a condition a form of localized morphea En Coup de sabre. it is a rather a clinical diagnosis and in most cases u do not need a skin biopsy unless there is evidence of other areas being involved. I have treated this condition in the past and another version of the same condition but with rather aggressive and wide spread involvement. u can see some of those pics on my website of Perry Romberg Syndrome. it can be improved upon significantly.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, you may benefit from botox.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Jonathan Kulbersh, MD · Answer

I recommend getting a consultation with a cosmetic dermatologist. Botox should be able to improve this. It takes 1-2 weeks for final results with botox. Hope this helps.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about botox.  Botox does not start working for at least 10-14 days post treatment.  However, the benefits should last 3-4 months.  The amount of units needed differs from person to person.  Typically 20-26 units are needed in the glabella area ("11's) in females.  Keep in mind some may not need that much, and men typically require more units.  
It is also important to keep in mind that several treatments may be required before more severe lines soften.  Regardless, it is important to decrease the muscle movement in order to improve moderate to severe wrinkles and fine lines.
  
To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Curtis Perry, MD · Answer

From your photo there certainly appears to be a vertical depression. I have found fat transfer to be an excellent technique for long term correction of defects in the facial skeleton.

Alix J. Charles, MD · Answer

Thank you for your question. My answer is going to be a little different from what the other experts are recommending.  I strongly suggest if you have yet to do so that you see an experienced dermatologist to be evaluated for a condition called morphea Coup de Sabre.  This forehead dent reminds me of that diagnosis.  If they are able to rule this out first, then they could possibly make recommendations regarding if Botox or a filler might work best for improving this problem. Best of luck to you.

Shaun Patel, MD · Answer

You are describing a contour defect in your forehead which would probably respond to treatment with a hyaluronic acid based filler like Restylane. Neuromodulators like Botox and Dysport are used for dynamic lines and wrinkles such as frown lines or horizontal forehead lines.

What can be done for this vertical dent in my forehead, it can only be seen in certain lights. (Photo)

Answers (11)

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