Forehead depression or irregularity

"I have a dent in my forehead" is a sentence that deserves more care than it seems. The type of depression matters: an old trauma mark, an irregularity after a filler, an area that sank with weight loss, or a recent change with no apparent cause call for different reasoning. The professional's first obligation is to find the cause before thinking about a product.

This page organizes the investigation of a forehead depression or irregularity and helps decide whether there is an indication for HOF (facial harmonization, in Brazil an orofacial harmonization specialty in dentistry), whether the case needs a referral, or whether the best course is not to intervene. The concern of a flat forehead, which is about projection and not a local depression, is in flat forehead.

What lies under the skin of the forehead

The forehead has the frontal bone, a layer of connective tissue, the frontalis muscle with the galea aponeurotica that connects it to the scalp, the frontal fat compartment, and the skin. Behind the bone, in the lower central region, is the frontal sinus, an air cavity. Important vessels and nerves, such as the supratrochlear artery, the supraorbital artery, and the supraorbital foramen, cross the area.

A depression can come from any of these layers, and palpation tells apart a good share of the cases: bone has a hard consistency and an edge; soft tissue yields to pressure; a surgical or trauma scar has adherence.

The most frequent causes

The table is a reminder that the same concern can fall within the scope of HOF, a dermatologist, a surgeon, or a physician investigating something else. The initial conversation should leave room for those possibilities.

When to refer before treating

A recent change in relief, associated pain, inflammatory signs, a trauma sequela without previous assessment, or a change in sensation justify medical referral before any aesthetic procedure. HOF does not replace the investigation, and injecting over an unclear cause can mask a condition that needs attention. Documenting the referral protects both the patient and the professional.

When the depression is old, stable, symptom-free, and of known cause, a discussion about volume is possible, with all the safety caveats. Even so, the expected benefit must be weighed against the risk, which is greater in a sequela area.

Depression after a previous filler

A frequent subgroup is the forehead that became irregular after a filler. The irregularity can come from uneven resorption, inadequate product distribution, nodules, or asymmetry in the injection. The assessment includes asking what was done, when, and with which material, and documenting the current state.

In these cases, hyaluronidase can be considered when the product was hyaluronic acid and the accumulation is irregular. When the product is unknown or is not hyaluronic acid, the approach is more cautious and involves assessing the nature of the material. See the topic of nodules for differential diagnoses.

What volume can do, when indicated

When the depression is soft tissue and the history raises no alerts, hyaluronic acid in a small amount can soften the irregularity. The area requires technique and preparation. The procedure is described at review level in hyaluronic acid in the forehead, and the complications in vascular occlusion in the forehead.

Other options, such as the biostimulator in the forehead and the skinbooster in the forehead, have restricted indications and their own risks. There is no risk-free option in the area.

How to organize the plan

1. Investigate the onset, trauma, surgery, and previous fillers.
2. Palpate and photograph with raking light.
3. Classify the probable cause and identify warning signs.
4. Refer when there is pain, a recent change, or an unclear cause.
5. If treating, use a conservative amount and reassess.
6. Record everything, including what was explained.

How to use Harmy in this conversation

Harmy has no marking point for the forehead, and the projection uses only the frontal photo, without simulating relief irregularities. For this concern, the app does not illustrate the result. It can be used, if there is interest, for other areas of the same patient's face, but the forehead depression has to be explained by other means.

Questions to test your reasoning

What to record in the patient record

Record the history of the concern, the photos with raking light, the palpation, the probable cause, and the warning signs that were checked. Note referrals, the conversation about risks, and the specific consent. For photos, see standardized clinical photography and, for complications, recording the complication in the patient record.

Frequent mistakes

The first mistake is filling without investigating the cause. The second is underestimating trauma or surgery sequelae. The third is injecting volume into an area with an unknown previous filler, without assessing what is there.

Summary for the decision

A forehead depression or irregularity starts with history and palpation, not with the product. Classify the cause, identify warning signs, and refer when there is pain, a recent change, or an unclear cause. When volume is indicated, use a conservative amount, keep hyaluronidase on hand, document, and act at the discretion of the licensed professional, in line with the rules of your professional council in Brazil, without promising results.