I have been reflecting on which substance is best suited for restoring volume in the temple hollows and the subzygomatic groove, especially in a lean 40-year-old patient. Which filler would you recommend — hyaluronic acid, poly-L-lactic acid, or calcium hydroxyapatite?

When I use hyaluronic acid for the temple hollows, I find that the filler feels somewhat soft and compressible. However, when I use calcium hydroxyapatite or poly-L-lactic acid, the distribution is less even, and these products cannot be dissolved with hyaluronidase. 

Both calcium hydroxyapatite and poly-L-lactic acid induce the desired fibrotic response, yet this also raises two concerns.

First, if the patient later requests further augmentation — which is often the case — I notice two challenges. The movement of my cannula is impeded by the fibrotic tissue, which can lead to an irregular result. Second, I suspect that within fibrotic areas, blood vessels are more fixed in place and therefore less able to move away from the cannula, potentially reducing safety.

I would very much appreciate hearing your thoughts on this topic.

I have been reflecting on which substance is best suited for restoring volume in the temple hollows and the subzygomatic groove, especially in a lean 40-year-old patient. Which filler would you recommend — hyaluronic acid, poly-L-lactic acid, or calcium hydroxyapatite?

When I use hyaluronic acid for the temple hollows, I find that the filler feels somewhat soft and compressible. However, when I use calcium hydroxyapatite or poly-L-lactic acid, the distribution is less even, and these products cannot be dissolved with hyaluronidase. 

Both calcium hydroxyapatite and poly-L-lactic acid induce the desired fibrotic response, yet this also raises two concerns.

First, if the patient later requests further augmentation — which is often the case — I notice two challenges. The movement of my cannula is impeded by the fibrotic tissue, which can lead to an irregular result. Second, I suspect that within fibrotic areas, blood vessels are more fixed in place and therefore less able to move away from the cannula, potentially reducing safety.

I would very much appreciate hearing your thoughts on this topic.