Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection

Abstract

Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a "fanned" pattern of injections, highly diluted filler injection, and the method we describe using a three-injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area.

Temporal volume increase after reduction of masseteric hypertrophy utilizing incobotulinumtoxin type A

“…The assessed improvements of the temple via the temporal volume scale was a two‐point improvement in one subject, whereas the remainder of the subjects displayed a one‐point improvement. Comparing the effects from the present study to other treatment algorithms, which utilized hyaluronic acid 22 or calcium hydroxylapatite 23 with improvements by two or three points on the temporal volume scale, reveal limitations in clinical effectiveness if this concept is thought to be utilized as a stand‐alone treatment for temporal volumization. The findings presented herein should not be considered as a new concept for treating the temporal fossa but rather an additional possibility for increasing the temporal volume.…”

Aesthetics and Rejuvenation of the Temple

“…Injection of fillers can be performed using hyaluronic acid, poly-L-lactic acid, and calcium hydroxylapatite. 9,11,12 These can be performed through a superficial fanning technique or through a deep bolus technique. In the superficial fanning technique, numbing creams are used prior to injections.…”

Specific aspects of a combined approach to male face correction: botulinum toxin A and volumetric fillers

“…In correction of the temporal area, it is necessary to avoid injury to the superficially located vessels and nerves. 5 The interfascial layers are considered in this context to be the most safe filler injection level. 6 The technical procedure that I suggest allows to inject the filler exactly into this level: the soft tissues of the temporal area are grasped between two fingers and are lifted over the muscle, and the needle or cannula is introduced into the base of the formed crease.…”

“…In correction of the temporal area, it is necessary to avoid injury to the superficially located vessels and nerves . The interfascial layers are considered in this context to be the most safe filler injection level .…”