Objectives: The aesthetic indications for filler injection in the temples are described, with an anatomic rationale for treatment supported by cadaver dissections and demonstration of injection techniques.
Introduction: The temples deepen over the years because of bone loss and soft tissue atrophy. The contours of the temporal crest and the zygomatic arch may sharpen with time. Increasing visibility of subcutaneous blood vessels and changes to the skin surface contribute to an older appearance.
Aesthetic judgement about temporal depth is subjective and culture-dependent.
Slightly hollow temples in beautiful faces need not necessarily be obliterated. Smooth transitions between the forehead, the temples and the midface have aesthetic value of their own.
Materials / method: A review of patient records and pictures was compared to the results of injections and dissection of cadaver heads with dyed filler. Representative film fragments of injection techniques were selected.
Results: Temple depth can be decreased by deep, intramuscular injection of specific gels. The efficiency is highest anterosuperiorly in the temporal fossa and lowest close to the zygomatic arch. The intermediate injection level under the superficial temporal fascia can be used to treat the entire fossa and to smoothen the contour of the temporal crest and the zygomatic arch. Subdermal injection helps to hide vessels but is more traumatic. Dissections show gel spread around the injection trajectory and a limited effect of remodelling by finger pressure
Conclusion: Various fillers are suitable for injection in three clinical injection planes in the temples. Besides temporal volume, smooth transitions to the forehead and the zygomatic arch are of aesthetic importance. Hiding the temporal vessels and biostimulation can be secondary objectives. Dissection studies suggest that remodelling filler after injectiong by finger pressure does little more than flattening the deposits. The spread of filler along the needle or cannula trajectory can be larger than intended.
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