Your Questions

Q: Dr. Eppley, I developed a depression/dent on the middle of my forehead that is circular after the birth of my second son. Whenever I bend over or pressure is applied to my abdominal area, the depression on my forehead fills up with fluid and a huge bump is visible. I have had a CT scan done and the results showed that it was not a dent on the skull surface, however it did not explain the cause. Why do I have it and will it ever go away?

A: The simple answer is I don’t know why you have it nor can I predict with any certainty if it will go away…but if I had to guess I would not think it is going to go away. Since the dent does to have a bone-basis for its presence, one can assume this is a soft tissue deficiency. That is predictable since if the dents as due to a bone issue, it would have been present essentially since birth. (short of some traumatic event) I have no doubt that the dent fill sour when you bend over but that is not because it fills with ‘fluid’ per se. That is probably due to blood vessel engorgement from the pressure which would be more obvious when the tissues are thinner.

What I would initially is to some temporary filler injections to make it more level and probably resistant to that bulging engorgement effect. If that us successful the you can eventually move on to a fat graft or fat injections for a more permanent result once you are assured that a soft tissue fill solves both problems.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have attached a number of pictures of my wife. She has a prominent forehead dent that is very bothersome to her. It even makes her appear more serious or even angry at time even though she is not. What could have caused this dent in the first place? What can be done for smoothing this out for my wife? I didn't really think that something can be done for this type of forehead issue until I came across your website. Thank you very much for your help.

A: Thank you for sending your wife's pictures. I believe what your wife has is known as linear scleroderma. This is a rare craniofacial condition in which the fat under the skin largely disappears and the overlying skin gets thinner. What is unique and easily identifiable about this condition is that it often occurs along a very distinct line. (hence the name Linear) While it can occur anywhere on the face, when it occurs in the forehead it appears as a straight line running right down the middle of the forehead vertically from the frontal hairline to the eyebrows. It always appears, as in your wife's case, as an indented vertical groove in the forehead. This is not a bone problem as the underlying forehead bone is usually normal. The groove is due to a soft tissue deficiency. (hence the name Scleroderma although this is not associated with the more generalized autoimmune disorder of scleroderma) It is not known why this unique soft tissue deformity actually occurs although it has a fairly classic presentation. It is not present at birth and only begins to appear in late childhood or teenage years. Its progression usually stops by early adult hood and progresses no further. (the indent does not get any deeper)

Treatment of a forehead linear sclerodermal defect is about soft tissue augmentation, building up the forehead indent from underneath the skin. I have treated them by a variety of soft tissue methods including fat injections and the placement of allogeneic dermal grafts or dermal-fat grafts. Any of these procedures can be completed in one hour of surgery. It may takes months to see the final result, in terms of volume retention and smoothness, as the fat or dermal graft survival integrates into the surrounding soft tissues.

Dr. Barry Eppley

Indianapolis,Indiana