Injectables / Rejuvenation Dermatology Calgary South

Temple filler, the area that frames everything above it

Hollow temples change how the whole upper face reads, and most people notice the effect long before they can name the cause. The temple is also one of the least forgiving places on the face to inject. Dr. Paul Kuzel, MD FRCPC, treats it with small volumes, deliberate depth and a clear understanding of what runs through it.

Book a consultation Call (403) 286-6888

What it is

Why temples hollow, and what filling them does

The temple sits in the temporal fossa, between the tail of the brow, the hairline and the top of the zygomatic arch. It is filled by the temporalis muscle and by fat pads above and below the temporal fascia, over bone that is thin to begin with. Every one of those layers can lose bulk.

Age

The superficial and deep temporal fat pads deflate, the temporalis thins, and the bone of the temporal fossa and the lateral orbital rim resorbs. The change is gradual and usually symmetrical, which is part of why it goes unnoticed.

Fat loss

Facial fat is among the first to go with significant weight loss, whether from illness, endurance training, dieting or medication. Temples and the area under the cheekbone often hollow before the body changes people were aiming for are visible elsewhere.

Constitution

Some people have naturally narrow temporal fossae and shallow soft tissue cover, and show hollowing in their twenties or thirties with no volume loss at all. That group needs a different plan from someone who has deflated over time.

Restoring a small amount of volume smooths the transition between forehead, brow tail and cheek. A hollow temple creates a visible step: the rim of the orbit and the zygomatic arch stand out as ridges, and the shadow between them makes the eye area look sunken and the face read narrow at the top and heavy at the bottom. Filling the fossa softens that step, so the light runs continuously from forehead to cheek. It can also make the tail of the brow appear better supported, though it does not lift the brow and should not be described as a brow lift.

12 to 18 monthsCommon duration of hyaluronic acid here, since the temple moves little
Small volumesChange is usually achieved with modest amounts per side, delivered slowly
High risk zoneSeveral arteries and a large vein cross the temple in different planes

Who it suits

Good candidates, and the ones we redirect

Often a good fit

  • A visible hollow in the temple with a step at the lateral orbital rim or over the zygomatic arch.
  • Facial volume loss following significant weight change, where the temples went first.
  • Faces where the upper third looks narrow and drawn while the lower face is unchanged.
  • Patients already having midface work, where treating the temple keeps the upper face proportionate.
  • Anyone comfortable with a subtle change assessed over several weeks rather than a dramatic one.

Often not a good fit

  • Prominent temporal veins that are visible under thin skin, where superficial injection carries added risk.
  • Very thin, sun damaged skin over the temple, where product can show as an edge.
  • Active infection, inflammatory skin disease or recent trauma in the area.
  • Pregnancy or breastfeeding, where these treatments are not offered.
  • Anticoagulant or antiplatelet therapy that has not been discussed, and bleeding disorders.
  • Anyone hoping temple filler will lift the brow or open the eye. It changes the frame, not the lid.

Product choice

Two approaches are commonly used, and they call for different materials. Deep placement directly on the bone of the temporal fossa needs a firm, cohesive hyaluronic acid gel with good lift, so it holds a shape under the muscle rather than dispersing. Superficial placement above the fascia needs a softer, more spreadable gel, sometimes diluted, so it does not create a visible ridge under thin skin. Juvederm, Restylane and Revanesse all include gels suited to one role or the other.

Where the hollowing is part of generalised facial fat loss rather than an isolated defect, a collagen stimulator can be the better choice. Sculptra is often used in the temples for exactly that reason: it produces a gradual, diffuse change over months rather than an immediate correction. Radiesse, usually diluted, is another option. Both are worth weighing against one significant difference: neither can be dissolved, whereas hyaluronic acid can.

What happens

The appointment, step by step

  1. Assessment

    Dr. Kuzel examines the temple from the front and in profile, looks for visible veins, checks skin thickness, and asks about weight change, medications and any bleeding risk. Both sides are almost never equal, and the plan reflects that.

  2. Choosing the plane

    Deep on the bone, superficially above the fascia, or a combination. The plane decides the product, the instrument and the volume. It is decided before the first injection, not during it.

  3. Marking and preparation

    Entry points are marked away from the known course of the superficial temporal artery and its frontal branch. Skin is disinfected and topical anaesthetic is applied. Most hyaluronic acid gels also contain lidocaine.

  4. Injection

    Deep placement is usually a single point, needle down to bone, with aspiration, then slow delivery of a small volume with minimal pressure. Superficial placement is usually done with a blunt cannula through one entry point, fanning above the fascia. Both approaches favour few passes and small amounts.

  5. Assessment upright

    Light behaves differently on a seated patient than on a reclined one. The result is judged sitting up, from several angles, before any decision to add more.

  6. Follow up

    Two to four weeks for hyaluronic acid, at which point a small top up may be added if it is needed. For a collagen stimulator, the plan runs over a series and is judged months later.

Afterwards

Downtime, and why this area needs an experienced injector

  • Swelling for two to four days. In the temple it can look like the correction is larger than intended at first.
  • Bruising is common here because of how vascular the area is, and it can track downward toward the cheek or the eyelid with gravity.
  • A dull ache or a heavy feeling on chewing for a few days, since the temporalis is a chewing muscle.
  • Avoid strenuous exercise, saunas and alcohol for 24 to 48 hours, and sleep with your head elevated the first night.
  • Do not massage the area unless you are told to.
  • Judge the result at four weeks. Allow two to three weeks before an event.

What runs through the temple

The temple is layered, and each layer carries something.

  1. Superficial temporal artery. It runs upward in front of the ear within the superficial temporal fascia and divides into frontal and parietal branches. The frontal branch crosses the temple in the very plane where superficial filler is placed.
  2. Middle temporal vein. A large, thin walled vein running roughly horizontally within or just deep to the superficial temporal fascia. Injecting into it can push product into the venous circulation, which is a recognised route to pulmonary embolism.
  3. Sentinel vein. A perforating vein near the lateral brow, often visible through the skin, marking a plane that should be respected rather than crossed blindly.
  4. Deep temporal arteries. These run under the temporalis muscle, close to the bone, which is exactly where deep supraperiosteal filler goes.
  5. Connections to the eye. The temporal circulation communicates with the supraorbital, supratrochlear and zygomatico orbital vessels, and through them with the ophthalmic artery. This is the anatomical basis for the rare reports of vision loss following temple injection.

What that means in practice

Serious complications in the temple are rare, but the ones that occur are among the worst in aesthetic medicine: skin necrosis, visual loss that is usually permanent, and venous embolism. There is no way to eliminate the risk. It is reduced by knowing which plane you are in, aspirating before deep injection, keeping volumes small, delivering slowly at low pressure, avoiding the known course of the superficial vessels, and stopping if anything does not feel right.

Hyaluronic acid filler can be dissolved with hyaluronidase, which matters both for a result you are unhappy with and for the emergency management of a suspected vascular event. Collagen stimulators cannot be reversed, and that is a fair reason to choose hyaluronic acid for a first treatment in this area. Any sudden vision change, severe or escalating pain, dizziness, chest symptoms or spreading skin discoloration after filler is an emergency. Call the clinic and seek care immediately.

See hyaluronidase for how hyaluronic acid is reversed, or cheek filler if midface support is being considered at the same time.

Questions

What patients actually ask

How much does temple filler cost?
It depends on how much product is needed and which product is used, and hollow temples vary a great deal in depth. Pricing is quoted at consultation after an in person assessment rather than published as a flat figure. A collagen stimulator is priced as a series rather than a single visit. Cosmetic injectables are not covered by Alberta Health Care Insurance.
Does it hurt?
Most patients find it manageable. Topical anaesthetic is applied first and most hyaluronic acid gels contain lidocaine. Deep injection onto the bone produces a firm pressure that some people find more uncomfortable than the needle itself, and it lasts seconds. A dull ache when chewing for a few days afterwards is common because the temporalis is a chewing muscle.
How long do the results last?
Hyaluronic acid in the temples commonly lasts around twelve to eighteen months, and sometimes longer, because the area moves very little compared with the mouth. Sculptra results build over months and often persist around two years after a completed series. These are typical ranges rather than guarantees, and metabolism, product and volume all affect them.
Why does the temple need an experienced injector?
Because of what runs through it. The frontal branch of the superficial temporal artery crosses the plane used for superficial filler, the middle temporal vein sits within or just below the superficial temporal fascia, the deep temporal arteries lie against the bone where deep filler is placed, and the temporal circulation connects to the ophthalmic artery. Complications are rare but include skin necrosis, venous embolism and vision loss. Safe treatment depends on knowing the plane, aspirating, using small volumes slowly, and recognising trouble early.
Which product is used in the temples?
It depends on the plane. Deep placement on the bone calls for a firm, cohesive hyaluronic acid gel that holds shape. Superficial placement calls for a softer, sometimes diluted gel so no ridge shows through thin skin. Dr. Kuzel carries Juvederm, Restylane and Revanesse, which each include gels suited to one role or the other. Where the hollowing is part of generalised facial fat loss, Sculptra or diluted Radiesse may be more appropriate, with the trade off that neither can be dissolved.
Will filling my temples lift my brows?
Not in the way a brow lift does. Restoring temporal volume smooths the transition from forehead to brow tail to cheek, and the tail of the brow can look better supported as a result. It does not raise the brow position or change the eyelid. If brow position is the actual concern, that is a different conversation and sometimes a different treatment.
How much swelling and bruising should I expect?
Swelling for two to four days is usual and can briefly look like an overcorrection. Bruising is common in this area because it is highly vascular, and it can track downward toward the cheek or eyelid. Allow two to three weeks before an event, and judge the result at four weeks rather than in the first few days.
Can temple filler be dissolved if I do not like it?
Hyaluronic acid filler can be dissolved with hyaluronidase, an enzyme injected into the treated area, and that option also matters in the emergency management of a suspected vascular event. Collagen stimulators such as Sculptra and Radiesse cannot be reversed. That difference is one of the main reasons hyaluronic acid is often chosen for a first temple treatment.

Next step

Start with a consultation

Dr. Paul Kuzel, MD FRCPC, is a board certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. Temples are assessed in person, in daylight and from several angles, before anything is planned. He sees patients in English and Czech.

Dr. Paul Kuzel, MD FRCPC
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102, Calgary AB T2W 4X9
(403) 286-6888

Book a consultation Call (403) 286-6888

Related pages: cheek filler, Sculptra, Radiesse, hyaluronidase.

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