Have vertical indentation on forehead and want it permanently gone. Would Ultherapy work or fat injection? (photo)

For most patients, long lasting fillers do a good job of taking care of this, even though they need to be repeated from time to time.  Ultherapy does nothing to fill defects, and fat grafting can be useful, but often needs to be repeated to give enough effect.

Based on the photos, I would recommend using a filler to fill in the indentation instead of Ultherapy or fat.  Ultherapy tightens skin but it doesn't add volume.  Fat does add volume but over the frontal bone sometimes fat can look lumpy and irregular.  Bellafill is a permanent filler than can be used in this area to fill in the indentation and to get a permanent improvement.  Bellafill has to be performed by an expert as the results will last a long time. 

Other than a surgical browlift, there are no "permanent" solutions to deep forehead wrinkles. The filler Sculptra® in the forehead can smooth forehead lines nicely and can last 18-24 months.

Dino, Although you may want a permanent fix at this time,
without a physical exam, a plastic surgeon can exclude ultherapy as offering no pertinent help, but cannot predict if   fat injections will work for forehead
indentations.   It sounds like there is
vertical-like muscle action  (from probably the
corrugators) involved, as Botox is suggested to work ,but only temporarily, to control the
vertical indentations. 


Botox, although is not obviously a permanent solution, it  is usually recommended first to control or
reduce the muscular action. Regular sequential treatment before muscular action
is grossly apparent will produce significant atrophy to the muscle to render it
barely functional after a while.  Then,
when there is no longer any muscle bulk or action contributing to the
deformity, if there is still residual fixed bony irregularity to the forehead,
fat injections or Radiesse have worked well  to produce lasting
smooth forehead contours with a natural feel when healed.  Even though Radiesse is said to last about 1.5
years, as it dissipates it gets partially replaced by collagen, so there is
often sufficient residual benefit for a longer period of time.  A touch up may be required after a couple of
years.  With fat there is also loss from absorption,
and multiple fat injections may also be required.


Other alternatives include permanent fillers or actual
computer contoured forehead plates but there are more risks associated with
these alternatives.


Best to consult a board certified plastic surgeon,
especially one with fellowship training in craniomaxillofacial surgery, to
review your history, physical exam, maybe obtain some radiologic studies to
clarify your individual anatomy.  Then
your plastic surgeon would be optimally informed to discuss your options, with
the risks and benefits that work for you.


Best of luck.