The forehead is a wide area of the face, but surprisingly, it is not always examined in detail.

 

However, when taking photos or looking at the side profile, forehead volume can have a significant impact on the overall impression of the face.

 

Especially when the central forehead is sunken, the area above the eyebrows looks pressed down, or the forehead line appears flat from the side, the face may look slightly tired or lack three-dimensional contour.

 

If you look at the attached before-and-after photos, the forehead before treatment appears generally flat, and especially from the side, the forehead line looks slightly compressed rather than smoothly connected.

 

After treatment, the anterior curve of the forehead appears smoother, and the upper face looks more defined in the side profile.

 

Of course, forehead filler is not a treatment that becomes more beautiful simply by adding a large amount.

 

In fact, because the forehead is a broad area, even a slight excess can create an unnatural rounded look. On the other hand, if the filler is placed too superficially or unevenly, irregularities may become visible.

 

That is why the important point in forehead filler is not “how many cc will be injected,” but “where the depression is and what kind of curve should be created.”

 

Forehead filler adds volume, but the key is the line

If forehead filler is viewed simply as a treatment that fills a depressed area, the result can easily look unnatural.

 

The forehead is an area that needs to be assessed not only from the front, but also from the side profile.

 

From the front, we need to look at the central forehead, the areas above both eyebrows, and the line that connects toward the temples. From the side, we need to observe the curve that runs from the hairline to the brow bone.

 

A natural-looking forehead is not one that protrudes excessively forward, but one that forms a smooth curve from top to bottom.

 

In the attached before-and-after photos, the point is not that “the forehead became very protruded,” but that the previously flat-looking line now connects more smoothly.

 

When this kind of change occurs, the overall face can look more refined, and the upper face can appear more dimensional from the side.

If you look at the photo above, the before-and-after images are marked as the same date, so they can be understood as changes immediately after the procedure.

 

Immediately after treatment, some swelling or volume from the recent injection may be reflected, so the final result should be evaluated after it has settled over time.

 

In other words, before-and-after photos are best understood as reference images showing how the forehead line can change in this direction. The actual duration and final shape may vary depending on the type of filler, injection amount, swelling, skin thickness, and movement of facial expression muscles.

 

How did the study classify the forehead?

 

One study that can be referenced regarding forehead filler is a 2018 paper by Kim.

 

This paper classified forehead depressions by type and described a forehead volume augmentation strategy using calcium hydroxylapatite filler.

 

The paper explains that forehead filler can help improve forehead depressions and wrinkles, but many clinicians approach it cautiously because of risks such as pain, intravascular injection, skin necrosis caused by embolism, and blindness.

An interesting point in this paper is that the forehead was not simply viewed as one “flat forehead” category.

 

The author classified forehead depressions into different types according to shape and severity, and suggested volume replacement strategies according to each type.

 

This means forehead filler is not simply a treatment that fills the center of the forehead, but a treatment that should be designed by reading each individual’s pattern of forehead depression.

 

In the paper, forehead volume augmentation was performed in 218 patients. The author described a method using a central entry point and tumescent solution to create space before injecting filler.

 

This approach was presented as a strategy that may help create space between tissue layers, check for vascular injury, and reduce injection resistance.

 

Of course, this paper studied calcium hydroxylapatite filler, and it does not mean that the same method should be applied to every forehead filler procedure.

 

However, it clearly shows an important concept in forehead filler: the type of forehead depression should be classified, and safe layers and routes should be considered carefully in an area where blood vessels and nerves are present.

 

Why is safety planning especially important for the forehead?

 

From the outside, the forehead may look broad and simple, but anatomically, it is an area where blood vessels and nerves must be carefully considered.

Blood vessels such as the supraorbital artery and supratrochlear artery run through the forehead and glabella area.

 

These vessels may connect with the vascular system around the eyes, which makes them some of the most important structures to consider during filler procedures.

 

In the forehead area, the supraorbital artery, supratrochlear artery, and their branches are important anatomical structures.

 

That is why forehead filler is not simply about injecting filler into a depressed area. The location of blood vessels, injection layer, entry point, injection pressure, and injection amount all need to be considered together.

 

Because the forehead is a broad area, filler that collects in one area can look lumpy. If placed too superficially, the filler may become visible or palpable on the surface.

 

On the other hand, approaching only a deep layer too aggressively may not produce the desired line if it does not match the individual’s forehead structure.

 

How should forehead filler design be assessed?

 

The first thing to assess in forehead filler design is the location of the depression.

 

We need to check whether the center is depressed, whether the area above the brows is hollow, whether the line toward the temples is lacking, or whether the glabella area is depressed and making wrinkles appear more prominent.

The next step is to assess overall facial balance.

 

Even if the forehead itself becomes beautifully rounded, it can look awkward if it does not harmonize with the nose, chin, and cheekbone lines.

 

For example, if the nose is low or the midface lacks volume, but the forehead alone protrudes too far forward, the forehead may look overly emphasized in the side profile.

 

On the other hand, in someone who already has a certain degree of nasal or chin projection, restoring a smooth forehead curve may make the overall facial contour look more balanced and dimensional.

 

As shown in the attached photo, when the forehead appears flat from the side, the goal should not be to fill it excessively. Instead, it is important to create a natural curve from below the hairline to above the eyebrows.

 

 

If an illustration is added here, it would be helpful to divide the forehead into the central forehead, brow-above area, and temple connection area, rather than showing the forehead as one single area to be filled.

 

What should be considered after forehead filler?

 

After forehead filler, temporary swelling, bruising, tenderness, unevenness, or asymmetry may occur.

 

In many cases, these changes settle over time. However, if severe pain continues, the skin becomes pale, the skin color becomes mottled, or any visual disturbance occurs, immediate medical evaluation is necessary.

 

The forehead and glabella are areas where vascular-related complications must be explained carefully.

 

Although rare, complications such as vascular occlusion, skin necrosis, and vision-related complications are known possibilities. Therefore, it is important to receive sufficient guidance before and after the procedure.

 

After forehead filler, it is also recommended to avoid strong pressure, massage, sauna, or excessive exercise for a period of time.

 

Before the injected filler stabilizes, external pressure may affect the shape.

 

In immediate before-and-after photos, the change can be visible right away, but the shape may change slightly as swelling improves and the tissue adapts.

 

That is why forehead filler should not be judged only by the immediate result. It is important to also observe how the filler settles naturally over time.

 

To summarize, forehead filler starts with design, not volume

Forehead filler may help add volume to a flat or depressed forehead and improve the three-dimensional contour and side profile of the face.

 

However, the important point is not adding a large amount.

 

We first need to assess which part of the forehead is depressed, how the central forehead, brow-above area, and temple connection area are connected, and whether the curve harmonizes with the overall facial proportions.

 

Also, the same amount and the same design do not suit everyone. The actual treatment should be determined after evaluating the forehead shape, skin thickness, vascular risk areas, and overall facial proportions together :)

 

This was Director Won Dae-han.

 

Thank you for reading.

 

Source:
Kim J. Novel Forehead Augmentation Strategy: Forehead Depression Categorization and Calcium-Hydroxyapatite Filler Delivery after Tumescent Injection.
Plastic and Reconstructive Surgery Global Open. 2018;6(9). DOI: 10.1097/GOX.0000000000001858.