Forehead filler remains a debated topic due to the inherent risks associated with the region’s vascular anatomy.
The FDA has recently approved Juvéderm Voluma XC for improving moderate to severe temple hollows in adults aged 21 and older. However, multiple other fillers have shown clinical efficacy in other forehead aesthetic concerns in off-label use.
This article explains the mechanism and benefits of forehead fillers, product options, and injection techniques for this high-risk area. We’ll also review the best practices and clinical data supporting the safe use of fillers in the forehead.
Key Takeaways
- Forehead fillers work by restoring volume to the subdermal tissues and diminishing the appearance of lines and folds.
- Hyaluronic acid-based fillers, like Restylane and Juvederm, attract water molecules, causing tissue expansion and improving skin plumpness.
- The benefits of forehead fillers include reduced frown lines and horizontal forehead furrows, and improved facial symmetry.
- Unlike surgical options, forehead fillers are non-invasive with minimal downtime and provide subtle, natural-looking results.
How Do Forehead Fillers Work?
Forehead fillers restore volume in the subdermal tissues, which diminishes the appearance of lines and folds.
Hyaluronic acid-based fillers, such as Restylane and Juvederm, attract water molecules due to their hydrophilic nature and cause tissue expansion with increased skin plumpness. The injectable substance also forms a scaffold beneath the skin for structural support.
Over time, hyaluronic acid is metabolized by hyaluronidase, but the effects persist because the filler stimulates collagen production through fibroblast activation. The induced collagenogenesis further supports the skin’s elasticity and firmness.
Forehead Filler Benefits
Forehead fillers have gained traction in aesthetic medicine because they have shown consistent benefits.
A study evaluated the safety and efficacy of forehead augmentation using a PCL-based dermal filler in 58 patients aged 20-65. It found a significant increase in Global Aesthetic Improvement Scale (GAIS) between months one and three that remained stable through 24 months. [1]
A recent case report also highlighted the use of dermal fillers as a minimally invasive alternative to surgical excision for the camouflage of a forehead osteoma. A hyaluronic acid-based filler was injected into the deep subcutaneous plane over the bony prominence using a cannula. [2]
Important benefits of forehead fillers include:
- Diminished frown lines (also known as “11 lines”) between the eyebrows
- Reduced horizontal forehead furrows
- Lifted droopy brows
- Improved facial symmetry
Who Is a Good Candidate for a Forehead Filler?
A good candidate for forehead filler for volume or wrinkles is an individual who meets the following criteria:
- Has persistent lines, especially after previous treatments like neurotoxin injections, threads, or skin resurfacing techniques
- Understands the potential outcomes and limitations of the procedure
Patients must be aware that forehead filler injections (except Juvéderm Voluma XC) are off-label and considered high-risk due to the proximity of critical vascular structures and the thin skin in this region.
There are also some candidates who are not a good fit for forehead filler treatment. They include:
- Patients with active infections, skin rashes, or dermatologic conditions such as acne vulgaris, rosacea, or eczema in the forehead region
- Patients with autoimmune diseases, particularly those affecting the skin (e.g., systemic lupus erythematosus and dermatomyositis), or individuals with a history of keloid or hypertrophic scarring
- Pregnant or lactating females
- Patients with known allergies to the filler ingredients (e.g., hyaluronic acid, lidocaine, or carboxymethylcellulose)
- Patients with bleeding disorders (e.g., hemophilia or von Willebrand disease) or those on anticoagulant therapy
Forehead Filler Injection Technique
Below is a detailed step-by-step guide for the forehead filler technique.
Pre-treatment Assessment
The first step is a comprehensive patient evaluation, including a detailed medical history and physical examination.
Assess the patient’s specific aesthetic concerns, such as dynamic and static forehead, and the degree of volume loss in the upper face. Determine the appropriate dose of filler based on your assessment.
1-2 mL of the filler is used for the first treatment, and additional filler can be injected during follow-up sessions at 4-week intervals to gradually build the desired effect.
Pain Management
Prior to injection, a topical anesthetic such as EMLA or LMX cream is applied to the forehead with a plastic wrap for better absorption, ideally 45 minutes before treatment. For further comfort, local anesthetic (such as lidocaine) can be injected into the treatment area.
Many hyaluronic acid-based fillers (e.g., Restylane Lyft and Juvederm Voluma) contain lidocaine within the filler. In addition, ice should be applied briefly to the treatment area before and after the injection to further reduce pain and swelling.
Injecting the Filler
Once the patient is adequately numbed, use alcohol and chlorhexidine to sterilize the treatment area thoroughly and minimize the risk of infection.
Use a 30-32 gauge, 1-inch needle to create a small puncture point that allows for smooth forehead filler cannula insertion while minimizing trauma to the skin.
The primary tool for injection should be a 25-27 gauge, 1.5-inch blunt-tipped cannula. The cannula reduces the risk of vascular injury and facilitates even distribution of the filler.
Follow these steps for injecting the filler:
- Mark an entry point near the temporal hairline and use the needle to make a puncture.
- Insert the blunt forehead filler cannula through the needle puncture. Avoid the supratrochlear and supraorbital arteries using the “pinch and pull” technique. [3]
- Slowly inject the hyaluronic acid-based filler in small aliquots.
- For superficial lines, inject into the upper dermis. For deeper folds, you may need to go slightly deeper. However, ensure you do not place the filler too superficially (which can cause lumps) or too deeply (which may lead to overcorrection).
- Gently massage the area to smooth out the filler.
- Apply gentle pressure with gauze to the treated area to minimize swelling and prevent bruising.
Post-treatment and Follow-up
Following the procedure, patients should be advised to apply ice intermittently to the treated area to minimize swelling and bruising. They should also avoid strenuous activities for 24-48 hours to prevent exacerbating swelling.
Schedule a follow-up appointment four weeks post-treatment to assess the results and determine if additional filler is needed.
Forehead Filler vs Botox: What’s the Difference?
Both forehead fillers and Botox can be used for aesthetic improvements in the forehead region.
Botox, a neuromodulator, works by temporarily inhibiting acetylcholine release. This relaxes the facial muscles responsible for horizontal forehead lines and glabellar lines. It is most effective for dynamic wrinkles caused by repetitive muscle contractions and typically lasts 3-6 months.
In contrast, forehead fillers are primarily injected into the subcutaneous layers to restore volume and smooth static wrinkles, which persist even at rest. They are beneficial for patients with age-related volume loss or sunken areas in the upper face.
Side Effects and Complications of Forehead Fillers
As with any injectable procedure, swelling and bruising are common side effects of forehead fillers and usually resolve within 48-72 hours post-injection. Mild pain, tenderness, or a feeling of tightness at the injection site can also occur, particularly if the filler is injected deeply or in large volumes.
In rare cases of forehead filler gone wrong, vascular occlusion may occur, leading to ischemia, necrosis, or blindness. Although rare, infection remains a risk with any injectable procedure.
Forehead filler migration — the movement of the injected filler from the original injection site — may also occur, giving patients an uneven or unnatural appearance.
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FAQs
How Long Do Forehead Fillers Last?
Forehead fillers can last from six months to 18 months with HA-based fillers and up to 24 months with calcium-based fillers.
Are Forehead Fillers Painful?
Forehead fillers cause mild discomfort, but they are not very painful because topical numbing creams and local anesthesia are used before the procedure.
How Much Do Fillers Cost for the Forehead?
According to the American Society of Plastic Surgeons, the average cost of hyaluronic acid dermal fillers is $715, while non-hyaluronic acid dermal fillers average at $901. [4]
References
1. Bae B, Lee G, OH S, Hong K. Safety and Long-Term Efficacy of Forehead Contouring With a Polycaprolactone-Based Dermal Filler. Dermatologic Surgery. 2016;42(11):1256-1260. doi:https://doi.org/10.1097/dss.0000000000000913
2. Lee KWA, Chan LKW, Hung LC, et al. Using dermal filler to camouflage forehead osteoma: A case report. Journal of cosmetic dermatology. 2024;23(11):3497-3502. doi:https://doi.org/10.1111/jocd.16471
3. Kapoor KM, Chatrath V, Li CQ, Bertossi D. Pinch Anatomy of Forehead: An Injection Guide for Forehead Filler Treatment. Facial Plastic Surgery. Published online January 4, 2022. doi:https://doi.org/10.1055/a-1730-8436
4. Dermal Fillers Cost. American Society of Plastic Surgeons. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/cost
