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The youthful temple region is characterized by a smooth and convex contour in which the bony margin of the skull is well-concealed. The temporal region is the interface between the scalp and the midface. It is a sign of youth, vitality and good health. In some cultures, a well-filled temporal region is also associated with wealth and prosperity, and filling of hollow temples is a popularly requested procedure.
The temple visually connects the scalp to the midface and has a smooth convex contour in youth. With advancing age, significant weight loss or severe illness, the temporal region becomes hollow and concave. The veins may become visible beneath the skin, and the chewing (temporalis) muscles become visible with minor movement of the jaw. The constellation of these changes increases the perceived age of the individual.
Common causes of hollow temples include advancing age, significant weight loss, and severe illness. Thinning of the skin at the temple region starts at the end of the third decade. There is reduced production of elastin, collagen fibers and ground substance.
A concavity forms at the temples due to reduction in subcutaneous fat volume. The veins lying in the subcutaneous space become increasingly prominent due to the skin thinning and the edges of the temporal bone starts to become visible beneath the skin.
There are two treatment options for hollow temples: filler injection and structural fat grafting. Both are simple and effective treatments that attain a high degree of satisfaction.
Temporal hollowing is reliably treated with filler injections and attains a high degree of satisfaction in most cases. Filler injection is a popular ambulatory procedure and is often used for restoring soft tissue volume in areas where volume loss has occurred. There is a wide range of fillers with various different characteristics to suit each individual’s unique anatomy and help them meet their aesthetic goals.
Individuals with early temporal hollowing and good skin quality are ideal candidates for filler injection.
The anatomy of the temporal region is complex and it contains important nerves and blood vessels that should be avoided when delivering filler injection. Injection of the temporal region is a fine art and requires appropriate product choice, precise execution and an experienced practitioner.
We use a proprietary technique of filler injection in the temporal region that will deliver an elegant and bespoke result. Injection site pain is significantly reduced with the use of a pain distraction device at Picasso Plastic Surgery.
The effects of filler injection may be observed almost immediately following the procedure. Most of the filler will be resorbed in 6 to 9 months and repeat treatment is required to maintain the result.
Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 2 hours following filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.
Dr Matthew Yeo is an experienced filler injector and is a trainer for several filler product lines. He frequently delivers lectures and conducts workshops on effective and safe filler administration in the Asia Pacific region. Injection site pain is significantly reduced with the use of a pain distraction device at Picasso Plastic Surgery.
Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery.
Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting is a minimally-invasive ambulatory procedure performed under local anesthesia, with optional intravenous sedation if requested.
Individuals with any degree of temporal hollowing and seeking long-term improvement are good candidates. Individuals with other areas of hollowing and volume loss may undergo concurrent structural fat grafting to the face, neck, or hands and achieve simultaneous benefit in multiple sites. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the temporal region using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 1-mm incisions that are well-concealed within the hairline.
Many individuals are able to return to work on the day after the surgery. Depending on the extent of liposuction performed, most of the swelling and bruising will resolve by the 7th postoperative day. Stitch removal is usually performed on the 7th postoperative day.
Individuals are advised to avoid pressure on the grafted areas to optimize graft survival. Face washing is possible on the 2nd postoperative day. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Bruising may be minimized by avoidance of strenuous activity for the first 2 weeks. Individuals may return to their original exercise and gym routines after 2 weeks.
After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 60 to 80% of the grafted fat will survive and the appearance at 2 months postoperatively is normally representative of the long-term result. The body absorbs the non-surviving fat during the first two months. The fat grafts that survive persist for many years.