How do I smooth out horizontal depression above forehead line? (Photo)

Question

1. I have this depression/dent arrea above my eyebrows that is very noticeable in sunny days. The area cast a shadow and makes it an eyesore. 2. I read up on fat grafting and derma fillers but not sure how to evaluate those two options. Is there an alternative that I am unaware of? 3. I heard injections near the forehead can cause blindness. How accurate is that statement, Thank you!

Nima Shemirani, MD · Answer

Hi @morales451! The forehead is a risky area to receive dermal fillers. There is important vasculature including the supraorbital and supratrochlear arteries. If you do proceed with dermal filler in the forehead, I recommended going to a plastic surgeon that has the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Jason Emer, MD · Answer

Neuromodulators (such as Botox, Dysport, Xeomin, and Jeuveau) and soft tissue fillers like Belotero can improve the appearance of the forehead by reducing lines, wrinkles and folds. Deeper lines and wrinkles need a combination approach with Botox, fillers, lasers, and microneedling/PRP. I recommend getting a formal evaluation with a cosmetic dermatologist to develop a treatment plan that works for you. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Fat grafting can volumize the desired area of the face to smooth the forehead depression you describe. Results from this surgical procedure are generally long-lasting and even permanent for some patients.
Another option might be a combination of neuromodulator and dermal filler injections. A neuromodulator such as Botox can soften the muscles attributing to the depression, while fillers can volumize the area for a smooth, natural-looking result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concern and help you decide on the best approach to achieve your aesthetic goals.

Cory Bovenzi, MD · Answer

Hi and thanks for your question!
The contour change you see there can be for two main reasons:1. as a result of the skull bone shape2. due to the prominent muscles of the brows (corrugators)
Thus, there are different treatment options:The skull bone shape can be altered especially by surgeons who do facial feminization procedures as this is an area that male to female transgender patients like smoothed as well. This requires surgery and drilling bone. There is a risk to the frontal sinuses during that kind of surgery.
If due to musculature, the thick muscles will relax and may be less prominent with botulinum toxin treatment (botox/dysport/xeomin/myobloc).
I would not recommend filler to this area because it would be unlikely to give you a result you would like- it would be hard to contour the filler perfectly and in a way to move with your brows without just causing the bulging to move further up your forehead (even though injecting filler to this area of the forehead would be extremely extremely unlikely to cause any vision or eye issues).

Jeffrey Lisiecki, MD · Answer

Best to be evaluated in person, but it looks like you have large corrugator muscles. I would plan to treat these with botox (or other neuromodulator) first and see how much the "ridge" is there afterwards (it may take a couple treatments for them to go down). Filler in this area can be dangerous, if the neuromodulator doesn't do it fat grafting would likely be the way to hide it further.

Geeta Yadav, MD · Answer

Thanks for your question! It’s likely that this indentation is from your skull’s natural contour, which is creating a shadow above your brows. If injected correctly, adding volume with dermal filler can help fill out this indentation. However, if too much is added, it could make the area appear bulky or unnatural. If this indentation is due to prominent brow muscles, it may be minimized with the use of Botox. An experienced provider examining your unique anatomy during a consultation will be able to determine the best course of treatment for your concerns. Good luck!

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! I see the depression on your forehead. There are options and it would depend on the anatomy on examination. If the area above your eyebrows is bony, a forehead reduction can help in that spot. This would involve crafting the bone to be less prominent. If it's muscle, trying Botox to weaken and soften the muscles may be a great choice. You can do fat transfer above in that area, but it can lead to irregularities and very rarely, issues with vascular occlusion. Consider a consultation with a facial plastic surgeon to see what may be the safest and best option for you. Hope this helps!

Bruce K. Smith, MD · Answer

It appears that the horizontal depression above your brows is related to the prominence of the strong muscles in the area and the bony prominence of the supraorbital rim. While fillers may help smooth the contour, it may make the area too full or heavy in appearance. A better treatment may be to use Botox first to weaken and thin the muscle below the indentation.