Vertical Forehead Depression? (photo)

Consulting with a well-trained and reputable provider should help determine what might work best for treatment. Cosmetic Botox, when injected expertly, will help eliminate the overuse/use of those muscles, and over time regularly treating the area will soften the line (s).

Botox will relax the muscles that are causing that deep crease between your brows and also the horizontal crease in your forehead. After the muscles have relaxed, your creases can be evaluated again to see if they need to be filled out with hyaluronic-acid-based fillers such as Juvederm. I hope this helps.

Thank you for the photos. Botox can help relax the muscles that are causing this. Your muscles haven't "separated", it's just that the skin overlying the muscles has creased this way. Fillers can help smooth this away if it's visible while not frowning as well.

From what your pictures show, it would seem that facial fillers or Botox injections would be an idea treatment to help overcome your vertical depressions. I'd encourage you to visit a doctor for a consultation so that you can be examined in person.

Juvederm and a combination of Botox may be the most effective. It's a good idea to visit a facial plastic surgeon to get examined in person.

Vertical clefts, dents or furrows are quite common between the eyebrows and on the forehead and result from the movement of muscles responsible for frowning or scowling. In my cases, two parallel lines are present, but it is not uncommon, as in your case, to see on line considerably deeper and longer than the other. Regardless, the treatment of choice for this problem is to address BOTH the overactive muscle movement and the inevitable etched crease that repetitive movement of the muscles in this region inevitably causes with time.

Although treatment for the muscle movement and for the crease can be performed at different sessions, in cases where it is obvious that the etched crease will remain prominent, I prefer to save time by taking care of both problems in one session. Neuromodulators, such as Botox, Dysport, or Xeomin, will take care of the exaggerated muscle movement that is the underlying cause. A filler, such as Belotero Balance, which can be injected very superficially and not leave bluish discolorations, can help improve the etch marks. and, if necessary, additional buttressing, support , and smoothing to the region can be achieved with injecting Juvederm UltraPlus XC slightly more deeply beneath the site. (An easy way to determine if both types of treatment are needed is to simply to pull the skin taut, which  would be equivalent to treating the muscles, and if a pronounced crease mark remains visible, the crease itself will likely require the additional treatment).

It should go without saying that consultation with a board certified aesthetic physician with extensive experience in treating such problems should be sought.

Hi Willow. Botox injections can get rid of your forehead cleavage. (Dysport would also work) These work by paralyzing the muscles that act to fold the skin to cause the furrow. You should give it at least 3 weeks after the botox or dysport injection to gauge response. If despite the paralysis of the frown muscles you continue to experience the problem, you may require a dermal filler such as juvedrm or radiesse to complete the job. Some patients would even opt for the use of dermal fillers alone as was done in the patient in this video using Radiesse:

This will only get worse with time. If a MRI shows the skull is normal then this is probably a midline separation of the muscle. This can be treated with Radiesse or a custom implant or tissue taken from another part of the body 

Deep vertical grooves on the forehead only get worse with time and age. Temporary fillers and botox are just that, Temporary. You should consider a permanent filler or implant since it most likely will drive you crazy as you get older and people think you are angry all the time. sincerely,

David Hansen,MD

Hi Willow--  I would approach this issue by recommending Botox during your first visit.  I would have you return to the office in 2-4 weeks and assess the degree of improvement.  At that point, we would discuss the option of fillers to soften the depression.  Be very careful and select a dermatologist with lots of experience.  It can be very dangerous to inject fillers in this region.

Take care,

Dr. Groff