Divots, Depressed Scars, & Other Concavities

I’m a 32 year old, Asian, female. I have a divot in the middle of my eyebrows from a steroid/Kenalog injection in January 2023. After the divot appeared, my dermatologist had injected more than 7 sessions of saline injections. However, it didn’t correct the divot. Later, they tried putting in Restylane Silk filler and now there’s a bump and some divot still left. It’s now almost August 2023 and it still looks horrible (some bumps and some divots)- will this ever go away? I’m starting to feel extremely depressed and not wanting to go out at all. Any advice? Any help? What’s the likelihood of it going away since it has already been 6+ months?

My heart goes out to you on this. Especially because it sounds like it’s right in the middle of your forehead, between your eyebrows. This is a spot that’s very hard to hide.

As you already know, most of these will self-correct in 3-6 months, but not all of them. But…there is hope and you have a number of options still. I’d be curious to know if your dermatologist just injected the saline or also did some gentle subcision under the divot? To do the subcision, the area would need to be numbed with a lidocaine injection first.

Some Options to Consider

  • A second opinion from another dermatologist. Good doctors are never offended if a patient does this.
  • Subcision may be able to get the collagen and fibroblasts (cells that make collagen) active again. Several treatments about a month apart would be needed.
  • Camouflaging it in the meantime is a good idea- like how your doctor tried to with the Restylane Silk. In my opinion, Juvederm or Juvederm UP could be a better choice since they are more malleable (at least in my hands) to get it more even. Your dermatologist could even take a syringe and transfer 0.2 into a tiny tuberculin syringe for better control. Your doctor can call our clinic Concierge Dermatology & Laser, if they would like me to talk them through this.
  • Laser treatment with a no downtime long wave laser. A long pulsed Nd:YAG laser would be a good option and there are others as well. These don’t cause a scab or bruise, but stimulate the deeper collagen.
  • Scars will often need multiple modalities to treat them like lasers, subcision and radiofrequency.

3 Questions to Ask Yourself Before Getting Professional Help with a Divot or Depressed Area

  • Can other people see this divot? Some people see things on their skin that no one else can see. If you’ve asked 3 people and no one else can see it, perhaps reconsider going to a doctor for this. Also, if you have to contort your face to see it, or it doesn’t show on normal photos, perhaps reconsider.
  • Is it possible that there is a brown spot there that’s causing the optical illusion of a depression in the skin? Remember the principles in art of light and shadow? It’s the same for skin. A brown spot may make an area looked depressed.
  • Is it your lighting in your bathroom? Most of us look in the same mirror each day to do skin care, and our lighting is not perfect. Check to see if you can see it in other mirrors.
  • Remember, there is a type of basal cell skin cancer that can look like a depressed scar and develops slowly over time. Definitely see a dermatologist if this could be the case.

I Hope this Helps,

Dr. Brandith Irwin, MD
Founder of SkinTour
Follow my skin tips and travels on Instagram!

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