Temple Fillers Singapore — Temporal Restoration

The temple is a shallow bowl of bone with a muscle in it. Three things change with age, and each deepens the bowl. The bone itself remodels: the temporal fossa widens and the zygomatic arch and lateral orbital rim become more prominent relative to it. The fat deflates: the subcutaneous layer thins, the superficial temporal fat pad between the laminae of the deep fascia shrinks, and the deep temporal fat — an extension of the buccal fat pad — recedes. And the temporalis muscle loses bulk, which happens with age, with weight loss, with endurance training, and with some medications.

Because the forehead above and the cheekbone below keep their width while the temple between them empties, the outline of the face changes shape. Injectors call the result the “peanut face”: wide at the brow, wide at the cheek, pinched at the temple. The eye sits inside this narrowing, which is why a hollow temple reads as a tired or smaller eye rather than as a hollow temple. The same deflation usually runs down the face, and the temple is often one finding in a wider pattern of facial volume loss.

Not every hollow temple is an ageing change. Some faces are built with a deep temporal fossa and a prominent zygomatic arch from the start; here the anatomy is skeletal, and the plan is about softening a contour rather than restoring one. Both are assessed the same way and treated with the same anatomical rules.

Temple filler suits someone whose temple is concave at rest, whose brow tail sits unsupported over that concavity, whose temporal skin has reasonable thickness, and who wants the face to look less pinched rather than fuller. It suits the person whose cheekbones look harsh because the temple beside them is empty — provided the assessment confirms that this, and not an over-filled cheek, is the finding.

It does not suit, or needs further assessment, in several situations. Very thin, translucent temporal skin with veins already visible will show superficially placed gel and may show the vein more afterwards. Previous permanent or unknown filler in the temple is a reason not to layer HA on top; the existing material is assessed first, as described under filler correction. Active infection on the scalp or face postpones treatment. Temporal headache or jaw-joint pain that has not been explained is assessed before anything is placed beneath temporalis. And where the cheeks have been over-filled and the temple only looks hollow by comparison, the plan may be to reduce the cheek rather than add to the temple — see ultrasound-guided filler dissolving.

Recovery varies. Swelling over the temple is expected and settles over the following days. A dull headache or a feeling of tightness on the treated side is common, and so is discomfort on chewing when the gel has been placed beneath temporalis, since the muscle now works over a new layer. Bruising can occur at the entry point or along the course of the vessels, more so if aspirin, fish oil or similar supplements are being taken. Temporary contour irregularity — a ridge where a sheet of gel ends, a soft lump, a temple that looks fuller than its pair — is common while swelling is uneven and the gel integrates, and is not the final contour. A vein may look more prominent for a while as the swelling presses on it.

What warrants review: pain out of proportion to what was done; skin that turns pale, dusky, mottled or blue-grey, or develops a net-like (livedo) pattern; blistering; any change in vision; a severe headache with tenderness over the scalp. These are signs of vascular compromise and are treated as an emergency. A firm lump that persists, a vessel that stays visible, or asymmetry once swelling has settled are not emergencies but should be reviewed rather than waited out.

Vascular occlusion is the risk that governs technique in the temple. The frontal branch of the superficial temporal artery joins the supraorbital and supratrochlear arteries, which are branches of the ophthalmic artery, so gel injected into it under pressure can travel backwards toward the eye. In the world literature reviewed by Beleznay and colleagues, filler-related visual loss has been reported from the temple as well as from the glabella, nose and forehead. Hence the artery is marked before anything is placed, the deep needle is aspirated and the gel injected slowly, the cannula is blunt, and hyaluronidase is within reach. The middle temporal vein is a second consideration: it is wide enough to carry gel into the venous circulation, which is why the plane between the fascial laminae just above the arch is avoided.

Visible vessels are the next risk. Gel placed superficially under thin temporal skin can make the vein beside it stand out, either by pressing on it or by thinning the cover over it. Over-filling is the third: a convex, bulging temple looks unnatural and adds width to the upper face, the opposite of what was wanted. Other risks: nodules; asymmetry; a bluish Tyndall tint when HA sits too superficially; infection; and transient numbness or tingling over the temple from irritation of the zygomaticotemporal nerve. HA filler is reversible with hyaluronidase, which is why it is the material used in this zone.

The cost of temple filler is set out at consultation, not on this page. The factors: the depth of the concavity and the volume the anatomy needs; whether one plane or both are used; whether the forehead, the cheek or a wider volume restoration plan is treated in the same visit; the product chosen, since HA gels and biostimulators are priced differently and not every HA gel has a rheology suited to this zone; and whether existing filler must be assessed or dissolved first. The dermal fillers guide explains how HA gels are chosen for different zones of the face.