Q: I would like to ask if you do use fillers for augmentation in the temple zone, where I have sufffered fat loss. If it is possible, what filers would you use? I look forward to hearing from you.
A: Temporal hollowing is a result of fat loss which occurs for a variety of reasons. Some people have it at birth, some develop it with aging, and others develop it from certain medications and surgical procedures. Either way, it is a deflation of the temporal muscle as the fat is lost underneath and around it. While synthetic injectable fillers can be used to fill it, it is not my first preference. This is because it takes a lot of filler to augment the area and, given that they are not permanent, is not a good value in the long run.
My choices would be either injectable fat, a synthetic implant, or a dermal graft implant. Any of these are surgically placed beneath the deep temporal fascia on top of or underneath the muscle. I have used them all and find that for most cosmetic augmentations (not caused by a craniotomy or temporal muscle detachment) the use of a subfascial dermal graft woks well. It is simple to do, is a natural collagen material that is soft and flexible, and appears to have good long-term retention. Some would argue that fat injections are best, and I do like them, but their volume retention is not as assured. Through a very small vertical temporal incision, sheets of dermal graft can be placed which fill out the hollowing very nicely.
Dr. Barry Eppley