Morphea En Coup De Sabre Treated With Combination Hyaluronic Acid Filler and Neuromodulator: A Case Report

Morphea en coup de sabre is a localized scleroderma variant that often leaves permanent, disfiguring frontoparietal atrophy after disease stabilization. We report a 27-year-old woman with four stable, linear, atrophic forehead plaques consistent with burned-out morphea en coup de sabre who sought cosmetic improvement. Targeted prabotulinumtoxin-A was administered to hyperfunctional temporalis, corrugator supercilii, and depressor supercilii muscles to reduce dynamic deforming forces. Two weeks later, hyaluronic acid filler was delivered via a blunt-tipped microcannula on the periosteal plane in a zonal pattern to restore contour. This combination approach provided immediate, natural-appearing correction maintained with small-volume retreatments every six to 12 months without complications. This case illustrates that neuromodulator and hyaluronic acid filler, delivered with a cannula, may offer a safe, minimally invasive option for aesthetic rehabilitation of burned-out morphea en coup de sabre by addressing muscle imbalance while reshaping and contouring the forehead.