The appearance of dents in the face can be a source of concern, prompting many to seek understanding about their origins. While some facial indentations are temporary and harmless, others may signal underlying conditions that affect the skin, fat, muscles, or nerves.
Transient Causes
Some facial dents are simply temporary marks resulting from external pressure. For example, sleeping with your face pressed against a pillow can leave temporary lines or indentations on the skin, which typically resolve within a short period after waking.
Similar temporary indentations can occur from wearing glasses, goggles, or other objects that exert pressure on the face. These marks are a normal physical response to compression. While the skin is young and supple, these folds typically vanish as collagen and elastin allow the skin to spring back into place. Over time, repeated pressure in the same areas might contribute to more persistent lines.
Skin and Subcutaneous Tissue Changes
Facial dents can also arise from changes within the skin itself or the fat layer directly beneath it. These causes tend to be more persistent and can range from common conditions to rarer dermatological issues.
Lipoatrophy
Lipoatrophy, the localized loss of subcutaneous fat, is a notable cause of facial depressions. This condition can lead to a sunken appearance, particularly in the cheeks, temples, and around the eyes. Causes of lipoatrophy include certain medical injections, such as insulin or corticosteroids, or it can be associated with chronic diseases like HIV, where some antiretroviral therapies can lead to fat loss. Trauma or specific medical conditions can also contribute to acquired lipoatrophy.
Anetoderma
Anetoderma is a rare skin condition characterized by a localized loss of elastic fibers in the dermis, the middle layer of the skin. This loss of elasticity results in areas of loose, wrinkled, or depressed skin. Anetoderma can be primary, meaning it appears without an obvious underlying cause, or secondary, developing at the site of other skin conditions such as acne or infections.
Localized Scleroderma
Localized scleroderma, also known as morphea, involves the hardening and thickening of localized areas of skin due to excessive collagen deposition. This condition can lead to sunken appearances, especially if the underlying fat, muscle, or bone is also affected. A specific form, linear morphea, can appear as a band-like indentation on the face or scalp, sometimes referred to as “en coup de sabre” due to its sword-strike-like appearance.
Severe Acne Scarring
Severe acne scarring is a common reason for indentations on the face. When deep acne lesions heal, they can result in atrophic scars, which are characterized by a net loss of collagen. These include icepick scars, which are deep, narrow, pitted depressions; boxcar scars, which are wider with sharp, defined edges; and rolling scars, which are broad depressions with sloping edges that create a wave-like texture.
Aging
Aging naturally contributes to changes in facial contours, leading to a more sunken appearance in some areas. As people age, there is a natural loss of collagen and elastin, making the skin thinner and less resilient. Additionally, the fat pads beneath the skin diminish in volume over time, which can cause hollowed features, particularly in the cheeks, temples, and under the eyes.
Neurological and Muscular Factors
Dents in the face can also stem from issues affecting the facial nerves or muscles, which play a significant role in maintaining facial structure and expression. These factors can lead to changes in muscle volume and tone, resulting in visible indentations.
Facial Nerve Palsy
Facial nerve palsy, such as Bell’s Palsy, primarily causes weakness or paralysis of facial muscles. Long-term disuse can lead to a reduced tone, or atonicity, which might give a sunken appearance on the affected side. This lack of muscle tone can impact facial symmetry and contribute to visible depressions.
Traumatic Injuries
Traumatic injuries to the face can directly damage muscles or nerves, leading to localized atrophy or scarring. Accidents, falls, or physical assaults can result in fractures of facial bones or severe soft tissue damage. Such injuries may disrupt the integrity of facial structures, causing depressions or unevenness that persist after the initial healing.
Muscle Atrophy
Muscle atrophy, a general wasting or reduction in muscle mass, can occur in the facial muscles due to various underlying conditions or prolonged disuse. This reduction in muscle volume can contribute to a gaunt or hollowed appearance in the affected areas of the face.
Seeking Medical Evaluation and Management
When facial dents are persistent, accompanied by other symptoms, or cause significant cosmetic concern, seeking professional medical advice is a sensible step. A medical evaluation helps determine the underlying cause and guides appropriate management.
It is advisable to see a doctor if the dents:
Appear suddenly
Are painful
Show signs of redness or swelling
Are associated with numbness or muscle weakness
Show rapid progression or significant changes in facial symmetry
A healthcare provider will typically begin with a thorough discussion of your medical history and a physical examination of the affected areas.
Depending on the initial findings, further diagnostic tests may be recommended, such as a skin biopsy to examine tissue samples or imaging studies like CT scans to visualize deeper structures.
Management approaches for facial dents are highly dependent on the identified cause. Treatments can range from observation for benign conditions to medical interventions addressing underlying diseases. For cosmetic improvement, options might include dermal fillers, fat grafting, or laser therapies, which aim to restore volume and improve skin texture.