The FDA's current dermal filler pages do not list the forehead as an approved area, and the agency's main filler page names the forehead, along with the area between the eyebrows, among unapproved uses. The FDA calls accidental injection into a blood vessel the most concerning risk of fillers: the chance is low, but it can lead to skin damage, vision loss (including blindness) or stroke. For most forehead lines, Botox is the usual first option, and whether filler has any place on a particular forehead is a decision for an in-person consultation.
Below is what the FDA pages actually say, what a blood vessel complication is, and the warning signs to know before any filler treatment.
Where FDA-approved fillers are meant to go
Dermal fillers are regulated as medical devices, and the FDA approves each product for specific uses in adults 22 and older. The FDA's dermal filler page (content current as of July 2023) lists these approved uses:
- Moderate to severe facial wrinkles and folds, such as the creases that run from the nose to the corners of the mouth
- Adding fullness to the lips, cheeks and chin, and to the back of the hand
- Restoring facial fat loss in people with HIV
- Correcting contour problems such as wrinkles and acne scars
The FDA's consumer update, "Dermal Filler Do's and Don'ts for Wrinkles, Lips and More," also lists under-eye hollows and the jawline for some products. Approval is product by product, so one filler may be approved for the cheeks and another for the lips.
The forehead does not appear on either approved list. The main FDA page goes further and names it: injecting the forehead, the glabella (between the eyebrows), the nose, the area around the eyes and the neck all sit on its list of unapproved uses.
What this means for you: if anyone suggests filler for your forehead, ask which product they plan to use, what that product is approved for, and why they are recommending it. The FDA also suggests asking for the product's patient labeling and reading it before treatment.
What a blood vessel complication is, in plain language
Filler is meant to sit in the tissue under the skin. Rarely, it ends up inside a blood vessel by accident, or presses on a vessel from outside. Either way, it can block blood flow to the skin and tissue that vessel feeds. Doctors call this a vascular occlusion, and Cleveland Clinic describes it as a rare but serious side effect of fillers.
According to the FDA, problems reported after filler enters a blood vessel include:
- Death of skin tissue near the injection site (necrosis)
- Vision problems, including blindness
- Stroke
Why the upper face gets extra caution: blood vessels around the brows and the bridge of the nose connect with the vessels that supply the eye. That is how filler in a vessel in this part of the face can, in rare cases, affect vision. It is also why the FDA's list of unapproved uses names the forehead, the glabella and the nose.
None of this is meant to alarm you. These events are uncommon. Knowing about them is simply part of making an informed choice.
How trained injectors lower the risk
No injector can make filler risk-free, but training and preparation make a real difference. The American Academy of Dermatology (AAD) points out that injecting filler is a medical procedure and that results depend largely on the experience of the person doing it. The AAD advises against getting fillers at spas, salons, parties or in someone's home. The FDA recommends seeking a licensed health care provider with experience in dermatology or plastic surgery.
In general, careful injectors reduce risk by:
- Knowing facial anatomy, including where the larger blood vessels run
- Choosing a product that is approved for the area and suited to the depth being treated
- Using properly labeled, sealed syringes (the FDA warns that fillers sold directly to the public may be fake or contaminated)
- Injecting slowly and watching the skin for color change as they work
- Having a plan, and supplies, ready in case something goes wrong
That last point is where hyaluronidase comes in. Cleveland Clinic describes it as an enzyme injected under the skin to break down filler. It acts on hyaluronic acid, the material in many fillers, and not on fillers made from other materials, which is one reason it helps to know exactly what is being injected.
Skip needle-free "filler pens" and do-it-yourself filler kits altogether. The FDA warns against both.
Questions you can put to any injector:
- How much training and experience do you have injecting filler in this area?
- Which product will you use? Is it hyaluronic acid, and what is it FDA-approved for?
- Is my treatment area an approved use for this product? If not, why do you recommend it?
- What is your plan if a complication happens during or after treatment?
- Which warning signs should I watch for, and who do I contact if I notice one?
Warning signs after any filler: get care right away
Some bruising, redness, swelling and tenderness are expected after filler. The AAD says these usually settle within 7 to 14 days.
Other symptoms are not expected. The FDA advises getting immediate medical attention if you notice any of the following during or shortly after a filler treatment:
- Unusual pain
- Changes in your vision
- Skin around the injection that looks white, gray or blue
- Signs of a stroke, such as sudden trouble speaking, numbness or weakness in the face, arms or legs, trouble walking, a drooping face, a severe headache, dizziness or confusion
Cleveland Clinic adds that skin over a blocked vessel may feel cool to the touch, and that symptoms can appear 12 to 24 hours after the procedure, so the warning signs matter for the day after treatment too. If you notice any of them, contact your injector right away. For vision changes or signs of a stroke, call 911 or get to an emergency room without delay.
Why Botox is usually the first option for forehead lines
Most forehead lines come from the muscle that lifts your eyebrows. Botox works by relaxing that muscle, and the FDA has approved Botox Cosmetic for treating forehead lines in adults. Filler does a different job: it adds volume but does not stop movement.
We explain how dermatologists choose between the two in Botox or filler for forehead lines, and cover brow position, timing and other practical questions in our forehead Botox FAQ.
Deciding in person
Both Botox and dermal fillers are part of the cosmetic services at Bay Ridge Dermatology in Brooklyn, and the practice offers complimentary cosmetic consultations. Whether filler suits a given forehead, or whether another approach makes more sense, is decided in person at a consultation. Bring the questions above with you. The consultation carries no obligation to book treatment, and if you choose to go ahead, the treatment itself is a separate cost. Cosmetic treatments are not covered by insurance.
The practice's team includes Dr. Evangeline Perez, a board-certified dermatologist with more than 20 years of experience. Individual results vary.
If you would like to talk through your options, book online or call (347) 497-4984.
This article is general information, not medical advice. For advice about your own skin, see a dermatologist.