Temple Fillers Singapore — Temporal Restoration

Temple fillers in Singapore treat temporal hollowing, a volume change in the small, vascular zone between the brow, hairline and cheekbone. A hyaluronic acid gel of moderate firmness is placed either deep on bone with a needle or under the skin with a blunt cannula, a choice set by anatomy at assessment, and it can be dissolved with hyaluronidase.

What temple filler is and how it works

Most people who ask about temple filler have not noticed their temples. They have noticed that the eyes look smaller or more tired than they feel, that the tail of the brow has dropped, that the cheekbone looks harsher, or that the face in a photograph has taken on a pinched outline: wide at the forehead, wide at the cheekbones, narrowed between. Injectors call this the peanut face. The temple is the concavity that produces all of these, and the eye sits inside the narrowing, which is why a hollow temple reads as a tired eye rather than as a hollow temple.

Why temples hollow

The temple is a shallow bowl of bone with a muscle in it, and three things change with age. The bone remodels, so the temporal fossa widens and the cheekbone arch and the outer rim of the eye socket stand out more. The fat deflates: the layer under the skin thins, the superficial temporal fat pad shrinks, and the deep temporal fat, an extension of the buccal fat pad, recedes. And the temporalis muscle loses bulk with age, weight loss, endurance training and some medications. The same deflation usually runs down the face, so the temple is often one finding in a wider pattern of facial volume loss. Some faces are simply built with a deep temporal fossa; then the plan softens a contour rather than restoring one.

What temple filler is directed at

• The temporal concavity: filler placed on the bone beneath temporalis, or as a thin sheet over the fascia, so the surface runs from the temporal crest to the cheekbone arch as a gentle curve rather than a dip.
• The brow tail: volume beneath the outer brow gives it something to rest on. This is support, not a lift.
• The frame around the eye: when the temple beside the eye is filled, the bony rim stops standing proud and the eye reads as less sunken. Nothing is done to the eye itself.
• The transitions: treating the temple in continuity with forehead filler above or cheek filler below keeps the contour continuous rather than stepped.

The layers it works in

The temple is a stack of layers, and two vessels cross it at known levels. From the surface down: thin skin, where veins can show; a thin layer of fat, where a sheet of softer gel can sit; the superficial temporal fascia, which carries the superficial temporal artery; the deep temporal fascia, with the middle temporal vein just above the cheekbone arch, a plane that is avoided; the temporalis muscle; and the bone, where a firmer gel can be placed with a needle.

Who temple filler suits, and who should wait

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.

Which filler and which plane: hyaluronic acid, CaHA or PLLA

Temple filler is defined by two choices made at assessment, the material and the plane, and the second usually decides the first. A deep concavity is rebuilt from the bone up with a firmer gel beneath the temporalis muscle; a shallow hollow or thin skin is smoothed with a thin sheet of softer gel over the superficial temporal fascia. Hyaluronic acid is the material used for a discrete temple hollow at this practice, because it can be dissolved in a region crossed by the superficial temporal artery and the middle temporal vein.

Poly-L-lactic acid is reserved here for diffuse deflation in which the temple is one zone of a whole-face plan; see the poly-L-lactic acid biostimulator page and collagen biostimulators. How HA gels are chosen for different zones is explained in the dermal fillers guide.

What is assessed before the plane is chosen

Four findings decide the plan: the depth of the concavity, judged from the front, the obliques and from above; the skin thickness over the fossa, because thin skin rules out superficial gel; the brow tail; and muscle bulk, photographed at rest and on clenching. Some temples need both planes.

How it differs from cheek filler, biostimulators and fat grafting

Cheek filler adds projection and width to the midface; temple filler fills a concavity above it. Collagen biostimulators work over a longer timeline and do not dissolve with hyaluronidase. Fat grafting is a surgical transfer with a survival fraction that varies and no enzyme to remove it if the contour is uneven.

What temple filler cannot do, and the alternatives

• It does not lift a descended brow. It supports the brow tail; a brow that has dropped, or heavy upper-lid skin, is assessed separately.
• It does not fix a face that looks hollow because the cheeks are over-filled. There the plan may be ultrasound-guided filler dissolving rather than more filler.
• It is not layered over unknown filler. Earlier long-lasting or unidentified material is assessed first.
• It cannot hide gel under very thin, translucent skin, where superficial filler can show or make a vein more visible.
• It does not treat skin quality. Texture, hydration and light reflectance are a different complaint from lost volume.

Two myths we hear in clinic

Risks of temple filler, stated plainly

Vascular occlusion is the risk that governs technique in the temple. The frontal branch of the superficial temporal artery connects with arteries that supply the eye, so gel injected into it under pressure can travel 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 in small increments, the cannula is blunt, and hyaluronidase is within reach. The middle temporal vein is a second consideration, which is why the plane just above the arch is avoided.

Other risks are a vein made more visible by superficial gel under thin skin, over-filling that adds width to the upper face, nodules, asymmetry, a bluish tint when HA sits too superficially, infection, and transient numbness or tingling over the temple.

• Pain out of proportion to what was done
• Skin that turns pale, dusky, mottled or blue-grey, or develops a net-like pattern
• Blistering, a severe headache with scalp tenderness, or any change in vision

What these look like and what happens next are set out on filler warning signs and complication care.

Questions worth asking before temple filler

• Which plane will be used for my temple, and why?
• Can the material be dissolved?
• Will the artery be mapped before injection?
• What are the warning signs afterwards, and who do I call?

What to expect: before, on the day and recovery

Before you book

• Declare blood-thinning medicines and supplements such as fish oil.
• Tell the doctor about any temporal headache, jaw pain or clenching, and if you are pregnant, breastfeeding or planning a pregnancy.
• Bring photos from earlier years and any record of previous filler in the face.

On the day

1. Photographs from the front, both obliques and from above, at rest and on clenching.
2. Palpation and mapping: the bony landmarks are marked, the pulse of the superficial temporal artery is traced, and skin thickness is judged.
3. Choosing the plane and the gel, for its behaviour in that plane rather than its brand. A written plan and quote is given, including the option of no treatment.
4. Placement after antiseptic preparation and topical anaesthetic: a needle perpendicular to bone, aspirated, with slow small increments; or a single cannula entry sited away from the artery. The temple is then moulded by hand.
5. Review of symmetry at the end of the visit and again once swelling has settled, when any small adjustment is planned.

Recovery and aftercare

Recovery varies. Swelling over the temple is expected and settles. A dull headache or tightness on the treated side is common, and so is discomfort on chewing when the gel sits beneath temporalis, since the muscle now works over a new layer. Bruising can occur at the entry point or along the vessels, more so with aspirin, fish oil or similar supplements. Temporary ridges, soft lumps or a temple that looks fuller than its pair are common while swelling is uneven, and are not the final contour. A firm lump that persists, a vessel that stays visible, or asymmetry once swelling has settled should be reviewed rather than waited out.

What determines the cost of temple filler

The cost of temple filler is set out at consultation, not on this page. The factors are the depth of the concavity and the amount and type of hyaluronic acid the anatomy needs; whether a deep needle placement, a cannula in the subcutaneous layer, or both are used; whether one or both temples are treated; whether the forehead, the cheek or a wider volume restoration plan is treated in continuity; and whether existing filler must be assessed or dissolved first. A written quote is given after Dr Sin Yong has examined the temples, and the consultation also decides whether treatment is advised at all. How quotes work is explained on how we quote.

How Dr Sin Yong approaches temple filler

Dr Sin Yong, an aesthetic physician, performs temple filler personally, and the questions of whether a hollow temple is worth treating, and whether filler there is reasonable, are answered by anatomy at consultation rather than from a photograph. In a face where both the temple and the midface have deflated, he assesses the temple before deciding anything about the cheek, because a hollow temple exaggerates the cheekbone and can make a cheek look as though it needs volume it does not need. Once the temple is filled, the cheek is reassessed.

“A hollow temple makes the cheekbone look wider than it is. Filling the cheek to match only widens the face further.”

Dr Sin YongOn why the temple is assessed before the cheek

He uses hyaluronic acid for a discrete temple hollow because it can be dissolved, marks the course of the artery before treatment, places volume in small increments, checks the outline from the front and from above, and waits for review before any adjustment. Where earlier filler is involved, it is assessed first, with ultrasound where needed.