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Q:

I am thirty now and have been lucky so far that my face is “youthful”. I have a couple of deepening horizontal lines on my upper forehead that I am considering filling. Also, I have a “bumpy” forehead. Nothing Wrong with my skin, this is just the cranial bone. I have a long, unnoticeable “dent” between my brown bones and the top of my forehead. I wonder if fillers would help this? I don’t want to look noticeably different. I’ve angled the photo so that shadows show where this dent would be!

Video on Forehead Rejuvenation

Dr. Pierone demonstrates the Serial Puncture Technique of placing a Ultra 50/50 blend just below the hairline to lift the forehead.

A:

Hello and thanks for posting.

The forehead is one of the best regions for fillers. Botox can help with dynamic lines, but does not address the volume loss. Like many aspects of facial rejuvenation, combination therapy often yields the best results.

The forehead can be filled with HA fillers. My favorite are Restylane Silk and Juvederm Ultra. We use these in a 50/50 blend with 1% lidocaine to make them thinner and less likely to produce bumps. There also is a safety factor in that they can be dissolved with Hylenex if the results are not optimal (have not had to do that though☺).
The forehead can be filled by using a serial puncture technique with the filler injected by back-filled insulin syringes – I learned this technique from Dr. Arthur Swift from Canada, kudos to Dr. Swift. However, in my practice I have moved more towards the use of a microcannula for delivery of forehead filler. This procedure is best done in a series of conservative treatment sessions to avoid overfilling the forehead and potentially producing vascular compromise. The sequential nature of the treatment also allows for correction of any minor contour irregularities if they develop.

Please see my demonstration video above this statement.

Regards,
Dr. Pierone

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