A Guide to Temporal Fossa Augmentation With Small Gel Particle Hyaluronic Acid Dermal Filler
June 2011 | Volume 10 | Issue 6 | Original Article | 673 | Copyright © 2011
Amir Moradi MD,a Azadeh Shirazi MD,b Veronica Pereza
aMoradiMD Facial Plastic Surgery, Vista, CA bScripps Clinic, La Jolla, CA
Loss of volume in the temple can result in a gaunt, wasted appearance. Dermal filler augmentation of the temples can counteract volume loss and achieve a more balanced and youthful appearance. Although the temporal fossa is a critical area for volume restoration of the aging face, published information is limited. The authors retrospectively describe the treatment of 20 female patients who sought facial rejuvenation and received small gel particle hylauronic acid (SPG-HA) injections for temporal fossa augmentation. The authors discuss a rationale for their choice of dermal filler and provide a detailed, illustrated injection technique guide for restoring volume in the temporal fossa region with SPG-HA. There is a need for prospective, controlled studies investigating safety, efficacy and persistency of hyaluronic acid fillers in this area of the face.
J Drugs Dermatol. 2011;10(6):673-676.
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Age-associated facial changes are a result of thinning of the epidermis, atrophy of subcutaneous fat layers, structural changes of the bones, loss of elasticity and weakening of underlying muscles.1 Soft tissue augmentation with injectable dermal fillers has become a standard treatment option for patients seeking aesthetic improvement of these changes throughout the face. Dermal fillers have been used primarily in treating the nasolabial folds. In recent years, however, the aesthetic field has come to appreciate their value in treating the lateral face, including the temporal fossae, to obtain a more youthful appearance.
Loss of volume in the temple can result in a gaunt, wasted appearance. This area of the face may not be as obvious as other facial folds or wrinkles, and may be overlooked by the patient and provider. Dermal filler augmentation of the temples can alter the upper and midface and achieve a more balanced and youthful appearance. When discussing treatment options for managing volume loss in the aging face, the medical aesthetic provider should consider the potential benefit of temporal fossa augmentation with dermal fillers.
Although the temporal fossa is a critical area for volume restoration of the aging face, there is limited information in the literature pertaining to this topic and even less information on how one may approach injection in this area. The purpose of this article is to review the authors' experience using SGP-HA for augmentation of the temporal fossa area and to provide a detailed injection technique guideline.
Background: Applied Anatomy
Soft-tissue augmentation with SGP-HA is considered a safe procedure associated with minimal to no downtime for the patient. To achieve optimal results and limit the potential for adverse events, the injector must have appropriate knowledge of the applied anatomy. Therefore, the anatomic layers of the forehead and temple, as well as the various planes for safe injection of fillers will be discussed. The temporal fossa is a shallow depression on the side of the skull bounded by the temporal lines and terminating below the level of the zygomatic arch.
The boundaries of the temporal fossa are as follows:
- Medial: Os frontale, os parietale, os temporale, os sphenoidale, os occipitale (bones of neurocranium).
- Lateral: The temporal fascia and overlying skin
- Anterior: Posterior surface of the frontal process of the zygomatic bone and the posterior surface of the zygomatic process of the frontal bone.
- Superior: Pair of temporal lines that arch across the skull from the zygomatic process of the frontal bone to the supramastoid crest of the temporal bone.
- Inferior: Zygomatic arch laterally and by the infratemporal crest of the greater wing of the sphenoid medially.
The temporal fossa contains the temporalis muscle and layered fascia, the superficial, middle and deep temporal vessels and the temporal branch of the facial nerve2 (Figure 1).