Q: Dr. Eppley, I have a very deep forehead line and am wondering what treatment options there are. I have attached pictures for you to see how deep this forehead lines is. Thanks in advance.
A: You have a very deep glabellar furrow. While there are a variety of synthetic fillers, implants and Botox injections as potential treatments, these would be ineffective with such a deep furrow caused by strong muscle action. The skin has become permanently etched and indented over time. The best treatment would be to treat it like a deep scar. (which to a large degree is what it is) I would excise the skin edges, implant a dermal-fat graft and close the skin in a broken line closure method. While you will always have a line/scar, the realistic goal is to make it less indented and have a more smooth outer contour.
While this approach may sound ‘radical’, a deep forehead line is an aesthetic problem that is resistant to every other injectable approach. It is now way beyond an expression line and has become a non-traumatic deeply indented scar. Substantial improvement in its depth can only come from surgical scar revision.
Dr. Barry Eppley