INTRODUCTION
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:
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).
