Augmentation of the forehead , albeit uncommonly performed is something worth looking into and understanding. It is not a region that is injected by the novice, as understanding the anatomy is key as well as realizing the right indication. Perhaps the most important part of the forehead that may be treated is the glabella . Although the part is fairly and readily injected with botulinum toxin , there are times that filler should be used to help remove etched lines caused by many years of frowning or non-treatment. In addition, fat compartments in the forehead do exist and those can atrophy with aging.

Patients do not generally present asking for augmentation of the forehead . Most will come to discuss the glabellar lines and the horizontal creases. The physician should inform patients especially those in their mid to late 40s that their forehead may benefit from fillers and the expected results will be softening of the lines as well as decreasing the concavity of the forehead head that occurs with time due to the loss of the fat compartments . The process also gives a youthful look and shine when performed, as the skin is brought back to its taut, original self. This is a holistic approach each and should be discussed during the consultation process. As a rule, patients will not come asking that their forehead be injected.

When treating the glabella , the injector should be aware of the major vasculature, pertinent to the area, most importantly, the supratrochlear artery . Damage to this artery can lead to neurovascular compromise affecting the forehead , with backwash embolism into the vessel, potentially also leading to the blindness . The vessel lies medial to the supraorbital foramen . Cadaveric studies show that the vessel lies in the general area of the vertical creases caused by contraction of the corrugator supercilli muscle. This is exactly the same area that is injected with fillers when treating the glabellar lines, meaning the injector is injecting right over the vessel. It is important to understand that though this may be the case, the supratrochlear artery originates deep from the bone, at roughly 1 o’clock in the right eye and 11 o’clock in the left. The vessel continues to lie below the corrugators till about 2 cm from of the superior orbital rim , where it then penetrates the frontalis and lies more superficial.

The other major vessel in the area is the supraorbital artery . This vessel lies more lateral to the suptratrochlear and can be readily palpated by feeling for the supraorbital foramen on the superior orbital rim . Damage to this vessel is uncommon as augmentation is not something that is readily performed in that area. Advanced injectors may use fillers and the best matter to avoid the penetrating the vessel and leading to a potential complication is to use a blunt tipped cannula, but the area is generally avoided. Damage to both vessels may occur to their branches higher up on the forehead when both vessels penetrate the frontalis muscle and are more superficial.

Other matters that need to be taken into consideration when injecting the area of the forehead are knowing the type of filler injected and knowing the level these fillers are injected. When injecting the forehead fat compartments and taking into consideration the stiffness and G′, fillers of low to medium G′ should be considered. This allows the fillers to be fairly distributed in the area without leaving any major lumps in the area. That being said, it is not recommended that the horizontal line be injected. Those lines tend to become less apparent with subsequent injections and not through injections of the lines themselves as the vessels are in the superficial plane in that area.