The six different injection techniques for the temple relevant for soft tissue filler augmentation procedures – Clinical anatomy and danger zones

Abstract

Objective The most promising facial region for inducing pan‐facial effects is the temporal region. The temple displays signs of facial aging itself which include temporal volume loss and increased visibility of the temporal crest, the temporal vasculature, the lateral orbital rim, and the upper zygomatic arch. The objective of this article is to provide a detailed review of temple anatomy pertaining to routinely performed temporal injection techniques, their expected esthetic outcomes as well as the intendant advantages, disadvantages, and procedure pearls. Materials and Methods This narrative review is based on the clinical experience of the authors treating the temporal region for esthetic purposes. The postulated outcome of each technique was observed during the routine clinical practice of the authors. Results The temporal region is based on a bony platform consisting of the parietal, frontal, sphenoid, and temporal bones. The overlying soft tissues are arranged in layers which contain the temporal neurovascular structures. The temporal soft tissues consist of 10 parallel layers which vary in their thickness depending on age‐related influences. Six different techniques will be addressed, which include subdermal and interfascial techniques for volumizing, low and high supraperiosteal techniques for volumizing, and supraauricular and temporal lifting techniques. Conclusion This narrative provides a detailed anatomic overview of the temporal region and describes each commonly performed injection technique with respect to anatomy, esthetic outcome, as well as potential pearls and pitfalls. It is hoped that the description contained herein may guide esthetic practitioners toward safer and more natural outcomes when treating the face.

Clinical validation of the temporal lifting technique using soft tissue fillers

“…Another technique described by Coimbra and colleagues 5 administers soft tissue fillers via multiple smaller boluses around the anterior and superior aspect of the auricle purported to yield similar results. Despite the retrospective analysis of a large sample of 165 participants, the authors did not provide objective and reliable evidence for their claims, leaving the study unfortunately in the realm of subjective anecdotal outcome reports.…”

“…Despite the retrospective analysis of a large sample of 165 participants, the authors did not provide objective and reliable evidence for their claims, leaving the study unfortunately in the realm of subjective anecdotal outcome reports. The first study however to report on the temporal lifting technique (as presented here) by Suwanchinda and colleagues 4,5 investigated the injection‐related outcome of 15 Asian patients and combined their results with skin vector displacement analyses of three Caucasian body donors. Their study reported convincing objective outcome measures for their (clinical) injection‐related outcome, but their 3D analyses were performed in a different sample.…”

“…The temporal lifting technique was described previously 4,5 . In brief, after topical disinfection with alcohol of the pre‐auricular area, cutaneous access was achieved 1 cm anterior to the apex of the tragus with a 21G needle, and a 22G 50 mm blunt‐tip cannula (Feeltech CO Ltd) was inserted.…”

“…The temporal lifting technique was described previously. 4,5 In brief, after topical disinfection with alcohol of the pre-auricular area, cutaneous access was achieved 1 cm anterior to the apex of the tragus with a 21G needle, and a 22G 50 mm blunt-tip cannula (Feeltech CO Ltd) was inserted. The entire length of the cannula was advanced in the subdermal plane in the superior direction until reaching the superior posterior temporal region.…”

“…To date, this temporal lifting technique 4,5 has gained increasing attention despite objective and reliable evidence for supporting the proposed underlying pathophysiologic mechanism still remains elusive. The objective of the present study is to analyze the ability of the temporal lifting technique to reduce the midfacial volume by soft tissue repositioning and to achieve an improved pan-facial appearance by exclusively targeting the subdermal plane of the posterior and superior temple with soft tissue fillers.…”