Dr. Suzan Alp | Forehead Dermal Filler

What is forehead dermal filler?

Forehead dermal filler is a procedure in which the delivery of a dermal filler product containing hyaluronic acid to the forehead area is assessed.

The product used is a medical device (opens in a new tab), and in Türkiye medical devices are monitored through the Product Tracking System (ÜTS) (opens in a new tab).

Two points to know first:

1. In vascular terms, this area is among the highest-risk areas in dermal filler procedures. The vessels running through the forehead and the area between the eyebrows are directly connected to the vascular network supplying the eye. Vascular occlusion in this area may lead to loss of vision. It is rarely seen; however, it requires intervention within minutes to hours, and this possibility is explained in detail before the procedure.

2. For lines on the forehead, the first procedure assessed is not dermal filler. The horizontal lines on the forehead are mostly related to muscle movement, and the procedure assessed in that presentation is described on the Forehead Botulinum Toxin page. Dermal filler is considered only in certain presentations and after a muscle assessment has been carried out.

The procedure is carried out at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.

Which factors determine whether the procedure is suitable?

The decision on suitability is made at the end of the consultation. The decisive factors in the assessment are as follows:

Whether the lines appear with movement, or are also present when the face is at rest
The bone structure of the forehead, and irregularities and hollows on its surface
Skin thickness (the skin in this area is thin, so the risk of the product becoming visible is higher)
The position of the eyebrows and whether there is sagging of the eyelids
Dermal filler previously applied to the area: its type and when it was given
Botulinum toxin previously applied to the area, and when it was given
Which medicines are being used, and whether there is a bleeding tendency

In lines that appear only with movement, this procedure has no place; in that presentation a muscle assessment is carried out.

In which patients is the procedure not performed?

In patients with a history of allergy to the product to be used or to its components
In patients with a history of allergy to the dissolving enzyme (intervention would not be possible if it were needed)
In pregnant and breastfeeding patients
In patients under 18 years of age

Situations that require separate assessment

Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
Active infection or febrile illness (the procedure is postponed)
Autoimmune disease in an active phase (the opinion of the relevant specialist physician is obtained)
Treatment that suppresses the immune system (the opinion of the relevant specialist physician is obtained)
Uncontrolled diabetes (healing may be affected)

Additional conditions specific to this area

The procedure is not performed if the following are present in the area to be treated:

An active infection, an acne lesion or an open wound

In these situations, the procedure is planned subject to the physician’s assessment:

Very thin skin (the risk of the product becoming visible, of irregularity and of a bluish change in colour is higher)
A non-absorbable type of dermal filler previously applied to the area (the opinion of the relevant specialist is sought)
Eyelid drooping or marked eyebrow drooping
A previous surgical procedure to the forehead or the head (the vascular anatomy of the area may have been altered; assessment by the relevant specialist is required)
A tendency to keloid or hypertrophic scarring (a raised scar that spreads beyond the original wound)

If the lines appear only with movement, this procedure has no place; a muscle assessment is carried out first.

How is the procedure performed?

Assessment. It is determined whether the lines appear with movement; if they appear only with movement, dermal filler is not planned. The structure of the forehead, skin thickness and the position of the eyebrows and eyelids are assessed. Any history of a surgical procedure to the forehead or the head, and previous dermal filler and botulinum toxin procedures, are asked about. Any history of allergy, bleeding tendency and current medication are recorded. Blood pressure and pulse are measured.
Product check. The ÜTS registration of the product to be used, the integrity of its packaging and its expiry date are checked. The dissolving enzyme must be available where the procedure is carried out.
Information and consent. The procedure, the fact that this area is among the highest-risk areas in terms of vessels, the possibility of vascular occlusion and of loss of vision, the risk of the product becoming visible and possible side effects are explained in detail; the form is signed. The symptoms for which help should be sought without delay after the procedure are given in writing.
Preparation. There must be no make-up on the area. Antisepsis is ensured.
Application. The product is given into the identified layer and in a measured amount.
Observation and follow-up. The patient is kept under observation after the procedure; vision and the area are assessed for signs of vascular occlusion. Vital signs and what is observed are recorded in the file. A follow-up appointment is given.

When is the effect seen, and how long does it last?

The appearance seen in the first few days is not the final result; the swelling is allowed to subside before the result is assessed.

The effect is temporary. The product used is absorbed over time; the duration varies from person to person, by area and by product, and cannot be stated in advance.

What should you do before and after the procedure?

Before the procedure, report:

A list of all the medicines and supplements you use (in particular blood thinners, painkillers and herbal products)
Your known allergies
Your pregnancy and breastfeeding status

Come with no make-up on the area.

What also needs to be stated for this area:

Have you had an operation on your forehead or your head?
Have you had dermal filler in this area before? When, and of what type?
Have you had botulinum toxin applied to this area before? When?
Is there any drooping of your eyelid or narrowing of your field of vision?

After:

Swelling and bruising are to be expected
The area must not be massaged or rubbed
You are asked to avoid bending forward, staying head-down for long periods and lying face down for the period given
Avoiding hats, bandanas and accessories that press on the forehead for a period is recommended
The period given for hot environments, saunas, sunbeds, swimming pools and intense exercise must be observed
You are asked to keep the written list of warnings you are given

Recommendations and time periods specific to you are given in writing at the end of the procedure.

Risks and side effects

In vascular terms, this area is among the highest-risk areas in dermal filler procedures.

Requiring urgent assessment

Loss of vision or a change in vision. This may develop as a result of vascular occlusion; the vessels of this area are directly connected to the vascular network supplying the eye. It is rarely seen but requires intervention within minutes to hours
Vascular occlusion. The signs: pain that is more severe than expected and increasing, blanching of the skin, a purple-red change in colour in a net-like or spotted pattern, coldness of the area
Tissue loss in the skin (necrosis)
Drooping of the eyelid or double vision
Infection and abscess at the site of the procedure

Other risks specific to this area

The product becoming visible and irregularity on the surface (reported more often on the forehead because the skin there is thin)
A bluish change in colour in the skin
Firmness or a nodule that can be felt by hand
Asymmetry
A change in the position of the eyebrow
Displacement of the product over time
A feeling of heaviness or tightness in the forehead
The expected change not being seen (if the lines appear with movement, no result is obtained)

General risks that may occur with any minor procedure

Swelling, bruising, pain and tenderness
Headache
Temporary change in sensation
Allergic reaction
Swelling and redness appearing at a late stage

Results vary from person to person. No guarantee can be given as to a result or a duration.

When should you see a physician without delay?

If you experience these symptoms during treatment, contact your physician without delay:

Drooping of the eyelid
Increasing redness, increased warmth, swelling or discharge in the area
A high fever
Crusting or the formation of sores on the skin
Widespread rash, itching

In the event of pain that is more severe than expected and steadily increasing, blanching of the skin, a purple-red change in colour in a net-like or spotted pattern, or coldness or paleness of the area, contact your physician at once; if you cannot reach them, go to the nearest emergency department. In the event of any change in vision, blurring, darkening or loss of vision, double vision, or rapidly increasing swelling of the lips and eyelids, go directly to the emergency department.

Frequently asked questions

What is the most serious risk of forehead dermal filler?

It is loss of vision as a result of vascular occlusion. The vessels of this area are directly connected to the vascular network supplying the eye, and in vascular terms the forehead is among the highest-risk areas in dermal filler procedures. In the event of any change in vision, consult a physician immediately.

Should I have dermal filler or botulinum toxin for my forehead lines?

The horizontal lines on the forehead are mostly related to muscle movement, and the procedure assessed in that presentation is described on the Forehead Botulinum Toxin page. Dermal filler is considered only in certain presentations and after a muscle assessment has been carried out. Which presentation is involved is determined at the consultation.

My lines only appear when I raise my eyebrows — is dermal filler suitable?

No. In lines that appear only with movement, this procedure has no place; in that presentation a muscle assessment is carried out.

Will dermal filler be noticeable on my forehead?

The skin in this area is thin; the product becoming visible, irregularity on the surface and a bluish change in colour are reported more often in this area. In those whose skin is very thin this risk is higher, and it is discussed before the procedure.

I have had botulinum toxin in this area before — will that be a problem?

This information needs to be stated at the consultation; botulinum toxin previously applied to the area, and when it was given, are taken into account in the assessment.

I have had an operation on the forehead area — is the procedure carried out?

In those who have undergone a surgical procedure to the forehead or the head, the vascular anatomy of the area may have been altered; the procedure is not carried out without obtaining the opinion of the relevant specialist physician. State the type and date of your operation at the consultation.

How long does the effect of forehead dermal filler last?

The effect is temporary; the product used is absorbed over time. The duration varies from person to person, by area and by product, and cannot be stated in advance.

Is forehead dermal filler carried out during pregnancy?

No. The procedure is not carried out during pregnancy or while breastfeeding.

Sources

Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz ve Ürün Takip Sistemi (ÜTS). https://www.titck.gov.tr/faaliyetalanlari/tibbicihaz (opens in a new tab)
Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz Yönetmeliği, Official Gazette 2 June 2021 / 31499 (repeated). https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=38657&MevzuatTur=7&MevzuatTertip=5 (opens in a new tab)
Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)

Forehead Dermal Filler