What is the cause of this indentation and dent mark in the frown on my forehead? (Photos)

Thank you for sharing your question and photographs. It appears that your indentation and dent are the result of movement of your forehead muscles.  This will improve if you are treated appropriately with Botox to help prevent their contraction.  I would perhaps seek a second opinion as 80 units is a large amount to receive and not have complete paralysis.

I would not suggest to use any more Botox at this time, 80 units is a lot. It looks like you have static frown lines, that may become more visible with age. Injecting intradermal Hialuronic Acid filler will correct it - my choice would be Juvederm XC or Vollbella.And the results are instant and stay for about 12 months. 

There are 2 ways to treat the glabellar creases. The first is to continue with every 3 month Botox. Eventually, over 12 or more months, this should improve to some extent. If your want a more effective and faster resolution of this problem, placement of superficial HA filler can be done. Keep in mind that this area has a higher risk for vascular occlusion and eye injury. However, if the injection is done by an experienced physician, the risks are minimal. I would inject Refyne in this area or Belotero. 

With 80 units, you should be seeing a result. That is a lot of Botox. In fact, it's probably too much. My best advice would be for you to schedule a consultation with another experienced injector for a second in person opinion. Best of luck.

Dear aiden7:It is difficult to tell from these static photos whether your muscles are completely relaxed and you still have a furrow because of years of frowning, or if your muscles are not yet completely relaxed, in which case more Botox could improve the furrows. You obviously have discussed this with your doctor, but have you asked this question?If your muscles are already completely relaxed, keeping up with the Botox before each treatment has completely worn off will eventually smooth over those furrows.  While you are waiting for that to happen, a small amount of filler (not Botox) in the furrows can smooth them over.I do think you may be able to achieve a great effect at a lower dose than what you have received. One possible explanation for your results could be that you received 80 units of Dysport, another botulinum toxin A with equivalent results to Botox at 3 times the dose (and typically one-third the cost per unit), not Botox?Again, 2-D pictures can be difficult to interpret, but I think I see an indentation just above the left end of your right brow, the part of your eyebrow closest to the glabella. Is this new or old, and is this what you noticed 3 months ago? It would be odd for this to develop after Botox treatment and I think an in-person evaluation is necessary to determine what is going on there. All the best,Dr. Clark

Aiden,First, 80 units of Botox in the forehead is a "boat load"!  Not getting complete paralysis with that much is very strange.I would seek out a second opinion as I feel you still need some more Botox to get the paralysis effects you are missing allowing your muscles to contract and form the 'dent'.Good luck with your search.Dr T

This is a combination of action of the corrugator and frontalis muscles and should have responded better to this amount of Botox. a combination of Botox and filler may be necessary to achieve what you want and be sure you see a board certified dermatologist

The cause for these lines is the glabellar muscle complex which should respond to relaxation using Botox/Dysport. 80 units of Botox is a lot for glabella and forehead and you should see considerable improvement. I would followup with another injector to discuss your concerns. 

Dear aiden, Thank you for your question.Persistent 11s can be divided into static and dynamic lines.Dynamic lines happen due to muscle activity. Botox reduces muscle action.Static lines occur due to dermal skin thinning from repeated muscle movement, and in your case, frowning. If your lines are static, then you would benefit from fillers. A combination of fillers and botox will help reduce your lines significantly, but will not erase them. I hope this helps.

Botox will help soften the lines by deactivating the muscle. Sometimes I fill them with filler products.  It will not eliminate the depression completely, but will soften it.