Can The Indent In My Forehead From Linear Scleroderma Be Fixed with a Bone Implant?

Q: Dr. Eppley, I have an indented line (most likely linear morphea) that started at my hairline and migrated vertically/diagonally down my forehead over the course of a couple years. I’ve had 2 fat transfers, and the dent always reappears 2 weeks after transfer. The first one the doc did was targeted but final results looked bumpy in parts while the dent came back just as prominent, so the second time, he did the whole forehead. The indent still retuned (see attached before and after pics) along with more bumps and depressions in different places. Is a forehead implant an option to help smooth out my forehead? It looks great the week after each fat transfer surgery, but when the swelling goes down, it seems the fat also doesn’t hold, or doesn’t hold in the depression where I need it and just hold in random bumpy spots elsewhere. I need something permanent, hence my inquiry about implant.

A: Linear scleroderma affects the soft tissue in its early or more mild forms and thus the fat grafting you have done, although unsuccessful, was the appropriate treatment for the anatomic location of the problem. An implant on the bone, while permanent, is likely not going to solve these multiple soft tissue contour issues that are up in the soft tissue and may well magnify them by pushing them out more. I would be very suspicious that a forehead implant would either not make a significant improvement or may make it worse.

Dr. Barry Eppley

World-Renowned Plastic Surgeon