Long-term Stability and Hyaluronic Acid Filler Selection for Forehead Contouring

Hyaluronic acid (HA) fillers have progressed from superficial wrinkle correction to tools for deep 3-dimensional facial remodeling. The forehead, once addressed exclusively through surgical procedures or botulinum toxin, can now be effectively reshaped using HA fillers. This retrospective study evaluates the long-term outcomes of forehead contouring in 38 patients (36 males, 2 females; mean age: 47.6 y) treated between January 2021 and January 2024 using a low G' (20 Pa), monophasic cross-linked HA filler. Injections were performed perpendicularly to the frontal bone, targeting the space just above the periosteum to correct frontal bossing and restore contour. The mean volume used was 16 mL per patient. No major or minor complications occurred, and patient satisfaction, measured through Visual Analog Scale (VAS), averaged 91 at 12 months. Follow-up up to 36 months demonstrated stable aesthetic results, with no evidence of filler resorption, nodules, or irregularities. The use of a low-cohesivity, low-elasticity filler allowed for precise molding and excellent integration without visible distortion, even in the thin tissue planes of the forehead. Despite the absence of a filler specifically designed for this region, this approach proved effective, cost-efficient, and safe. These findings suggest that deep HA filler injections may offer a reliable, reversible, and long-lasting alternative to surgical forehead contouring. Further randomized, controlled trials are needed to define the ideal rheological parameters for forehead applications.