Most people are aware of dermal fillers being used to enhance the volume and appearance of the lips, but did you know that fillers can also be used in other parts of the face to replace lost volume and minimise the appearance of ageing?
One area which is often overlooked is the temples, which is surprising, as the loss of volume in temples can have a profound impact on the appearance of the face, making us appear much older. It often takes an expert facial assessment with a highly experienced injector to notice that adding volume by fillers to the temples can make all the difference.
Treatment of temple hollows, when considered as an important part of a facial rejuvenation treatment course, can make you look refreshed and more youthful. You can think of it as a “non-surgical facelift”.
The word “temples” comes from the Latin word “tempus”, meaning “time”. This is because the hair at the temples is often the first to turn grey or white with the passing of time. The face temples also show the passing of age in other ways that we often don’t notice consciously, but which can have big effects on the appearance of the face. The good news is that hollow temples can be treated non-surgically and very quickly, with dermal filler.
The temples are the area to the edge of your brows, running up and backwards to the hairline. It’s the area which we may massage to relieve a tension headache. If you clench your jaw on and off while pressing the area you’ll be able to feel the contractions of the muscle “temporalis”, one of the chewing muscles. You may also be able to feel the pulsing of the temporal artery underneath your fingertips.
WHY DO WE LOSE VOLUME IN THE TEMPLES? HOW DOES IT AFFECT OUR FEATURES?
The youthful face is usually full and firm with round or “convex” temples, flowing down through full cheeks into a thinner jaw; it’s the “heart shaped face”.
The temples are vital to creating this structure, or scaffold for the rest of the face. As we age, we naturally lose bone in the face, especially in the cheeks, under the eyes, and in the face temples. We also lose fat from the natural “fat pads”, again in the cheeks, under the eyes and temples. You may think that losing fat in the face is a good thing, but in certain areas it’s the fat which helps to support the skin and give the face the structure that it needs to remain youthful looking.
As we age we also lose collagen in the skin. Collagen is the protein which keeps out skin “springy and tight”, which helps to minimise wrinkles. Without the underlying support of the bone, fat and collagen in the skin tends to sag, leading to hollow cheeks, bags under the eyes, and hollow temples.
A concave (sunken) depression can form between the brows, the cheeks and the hairline, which can make the outer bony ridge around the eyebrows and eye socket appear more pronounced. Not only does this make our temples look sunken and gaunt; it also means we lose the scaffold for the rest of the face. The skin over the temples sags, worsening the appearance of wrinkles around the eyes (“crow’s feet”). The whole balance of the face shifts downwards, and we lose the “heart shaped face”, which is replaced by a more “square” appearance.
By replacing volume with fillers in the temples, under the eyes and in the cheeks, we aim to restore a more youthful and refreshed appearance, which aims to reverse the sunken and tired look of the aging face. The effect can be very subtle but can dramatically improve the overall appearance of the face.
WHO IS LIKELY TO GET HOLLOW TEMPLES?
The ageing process seems to occur more quickly and in a more pronounced fashion in some people than in others. Volume loss in the temples particularly affects slimmer people who naturally have less volume to begin with.
It can also be very noticeable in people who are very athletic, and those who lost a lot of weight. The process may begin in the late twenties, but it’s a slow, gradual loss of volume, and it may not be noticeable until later in life. In fact, as not many people are aware that volume is lost in the temples as we age, it’s something that tends to go unnoticed. It’s only when it is treated by an experienced facial assessor and injector that the amazing differences can be seen!
HOW IS VOLUME LOSS IN THE TEMPLES TREATED?
Volume replacement in the temples should be considered as part of a complete facial rejuvenation treatment program and often goes hand in hand with anti-wrinkle injections around the eyes and fillers in the cheeks and under the eyes. In fact, filler in the temples can dramatically improve the appearance of lines around the eyes by giving a mini-facelift that “stretches and lifts” the skin at the outside and upper edges of the eyes. When combined with other anti-ageing treatments, such as laser genesis which restores collagen, fine lines and wrinkles can also be treated.
WHAT SHOULD I EXPECT DURING FILLER INJECTIONS TO THE TEMPLES?
It’s important to choose an experienced injector who understands the important anatomy underlying the skin in the temples, especially the veins and arteries which should be avoided. Depending on the individual situation and the anatomy, your injector may decide to inject with a needle or a blunt-tipped cannula.
Your injector will assess your temples and face for the degree of hollowness and volume which needs replacing, as well as for any underlying asymmetry. Filler before and after photos will be taken so you can compare your “before and after” results.
Some people may have experienced more volume loss on one side than on the other, which will need correcting. After thoroughly cleaning the skin with antiseptic, ice is used to numb the skin and help constrict any small veins to minimise the chance of bruising. Usually one injection is enough for the majority of the dermal filler to be injected deeply into the face temple on each side. The area should be massaged following the injection to help spread the filler and avoid any lumps.
I like to inject one side first, and then stop and show the client with the mirror. It’s often amazing to compare the treated side with the non-treated side, as the difference in volume can be dramatic! The other side can then be injected. I actually like to leave a small amount of filler for each side in reserve, rather than inject the whole amount on each side in one go. That way the client and I can look together and decide if one side needs more than the other.
It’s a team effort, and I like my clients to be involved in the dermal filler treatment decisions. Usually it only takes two tiny injections on either side. The filler itself contains a local anaesthetic, so the area starts to become numb fairly quickly, and because of the ice used on the skin, most people find the experience very comfortable and painless.
WHAT TYPE OF FILLER IS BEST IN THE TEMPLES?
Different types of filler are thicker than others, and each has its purpose and should be used in specific areas of the face. A softer, more malleable filler should be used for lip fillers, but in the temples, where we are aiming to replace volume, fat and bone, we need to use a thicker, stronger filler with more structure. The added benefit is that these thicker fillers also tend to last longer. You can expect your temple filler treatment to last for approximately twelve months on average.
WHAT SHOULD I EXPECT AFTER FILLER INJECTIONS TO THE TEMPLES?
Most people find filler treatment in the temples to be a very comfortable treatment, and there is significantly less discomfort and swelling than lip filler injections. Some people may experience a slight ache in the jaw or while chewing for a day or so, due to the injection around temporalis, the “chewing muscle”. Ice to the area may help for the first evening, as well as mild painkillers such as paracetamol.
Aspirin and ibuprofen should be avoided as they thin the blood. Some people find that spending the first night lying on an extra pillow can minimise the swelling experienced when they wake up the next morning. If you do have any small bruises, arnica cream can also be helpful. Any bruises and swelling should resolve in a day or two. In general this treatment is very well tolerated. Your injector will contact you over the next few days to check up on you.
HOW MUCH FILLER DO I NEED IN THE TEMPLES?
Everybody has experienced different degrees of volume loss in the face over the years, and everyone needs different volumes of volume replaced. On average, about half to one ml should be injected to each temple at a time for a noticeable difference to be seen. Remember that filler expands over the first few weeks as the molecules naturally attract water.
That’s one of the reasons why I like to see my clients for a review two or three weeks after their treatment. At that review we can decide if more dermal filler is required. It’s a good idea to slowly fill the temples and cheeks over a period of months, slowly replacing volume in a fashion that aims for a more gradual, natural looking restoration and rejuvenation.