Vertical Forehead Depression? (photo)

Hello, for the past 7 or 8 years I have lived with what I call a forehead cleavage! I'm 29 and I can't stand the idea of living with it in my 30s. I have a very small vertical wrinkle in the middle, just above my eyebrows, but that doesn't bother me too much. The deep vertical furrow, or depression, that stretches almost across my whole forehead, does though. I can see it in all of my photos, when I walk past shop windows, I can always see it! It is almost as if the muscles have separated?

Doctor Answers 19

Forehead wrinkles...and Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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).

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Botox and fillers for forehead depression

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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 

William Groff, DO
San Diego Dermatologist
4.9 out of 5 stars 51 reviews

Vertical Forehead Crease and 'Number 11' Sign

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello 'WillowIris', thanks for your question.  You suffer from hyperactive glabellar muscles (procerus & corrugator supercilii) which often leads to the 'number 11' sign, which are 2 vertical creases on the forehead.  In your case, it looks more like you have just one vertical crease.  Regardless, this dynamic crease can eventually become permanent if the muscles are activated over and over, leading to an indent in the skin.  The best way to prevent this is to have muscle relaxant injections to this area with products such as Botox or Dysport.  If you have already developed a permanent crease, then this can be smoothed out with a filler product, such as Restylane or Juvederm.  Although with the lack of regulations, everyone and their mother are injecting these products today, I recommend going to a board-certified plastic surgeon who has had extensive training in facial anatomy and understands how to give you a nice, aesthetic result.  Good luck!


Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon

You might also like...

Botox Can Erase Forehead “Cleavage”

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Botox and fillers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Botox For Vertical Depression

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Kimberly Butterwick, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 20 reviews

Botox For Forehead Lines

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Vertical Furrows, "Cleavage Lines," And Dents Respond Well To A Combination Of Neuromodulators, Fillers, And Volumizers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Forehead Crease

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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:

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Question: Vertical Forehead Depression

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi Willow:

Neuromodulators such as Botox do very well in the upper 1/3 of the face, in the treatment of "dynamic lines" (lines caused by underlying muscle contractions).  Botox temporarily weakens the muscles responsible for the lines between the brows ("number 11" sign). 

Hope this is helpful.


Anand G. Shah, MD

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.