What filler do you like most for the temporal fossa?

Artefill.

I like the Vampire Lift. It seems to work very well.

Radiesse works really well, especially when you have visible veins, which can be camouflaged by the whiteness of the product (and it lasts the longest!)

I have been injecting dermal fillers for 16 years. I have had good results with both H.A. products and Radiesse. The key is to know your anatomy and to inject slowly.

MM, if veins are visible through skin and you are injecting deeply how are they being covered by color of product? Can you give me tips on how to avoid compression of the veins?

MM is right about color "mixing" and camouflage. The identical process is used to conceal skin imperfection with make-up. To conceal blue/dark blue/black you need to use a base with yellow-based pigment. What color to use to conceal different hues one could use a simplified method of looking at the opposite spectrum of the color wheel. Radiesse, if superficially injected, appears yellowish although it is pure white. It is effect of "colloidal" layer of the skin and effect similar to Tyndall's effect that depends on difference between the properties of reflected and scattered light and the wavelengths. Placing Radiesse along the venous branches will definitely produce a concealing effect. Of course, it will work only if injected in the same plane, particularly in temporal area. If injected below the thick temporal fascia and temporal muscle, it will have no effect on superficial veins. There should be no concern about compressing veins in temporal area regardless of the filler.

I have stopped filling temples at the moment. There have been reports of blindness following treatment in this area. As I understand it you can never be 100% certain where the vessels are. I used to inject Sculptra or Radiesse. I would be interested to hear other people's views.

I disagree with raychell.. If you are familiar with the the anatomy of the face and carefully inject the fillers you do not get any complications. It is rather hard work but if you are well trained you can do it easily. Ask patients to move their head down and do the Valsalva maneuver so you can see where the vessels are. In general, temporal vessels are important and close to the scalp.

Volume loss in the temples is due to bone loss which is very common in women as part of normal ageing and is an important area to treat for aesthetic reasons, especially if you are volumizing the cheeks as this will make the temple volume loss more apparent . Correction of temple volume loss will need 1-3ml of product for correction each side and I would not consider HA or Radiesse to be safe . I use Sculptra as the water and lidocaine suspension allows for a reflux manuever before injection , if blood is withdrawn then you are in a vessel stop and apply pressure. Always inject slowly. Even in the worst case scenario of injecting Sculptra into an artery , being a water based suspension it would not cause embolisation . I agree with that it is not an area where an inexperienced injector should try unless they 100% sure of the facial anatomy.

Correction of temporal fossa can be safely accomplished using cannula. Depending on the length of cannula you can re-direct it and extend your injection field, if needed, to the zygomatic arch, buccal and pre-auricular areas. There are two convenient entry points I use, the first is about 1.5-2 cm in front of the upper edge of targus and the second located in the "safe zone" up to 2 cm behind the lateral orbital rim.

Indeed, the anatomy will always dictate all the injections, anywhere. I assume the major fear in temporal area is the intra-arterial injection in the frontal branch of superficial temporal artery that runs somewhat diagonally from the external acoustic canal toward the lateral brow and about 2 cmm above it. Sometimes this branch is very tortuous and injection near its path could cause its puncture. With cannula, the risk is minimal, if any. Sculptra is always a good choice in this area; otherwise, I use Radiesse.

Restylane SubQ is a 2 ml syringe. Excellent outcomes filling the temporal fossa. I palpate and mark temporal artery near hairline. I get the patient to sit forward with their head down, cover nose and mouth and blow (not letting air out). This makes the temporal veins visible. I mark them with a white eyeliner. Then inject in 2 sites per temple close to bone

HA fillers are always a good choice. Which one? Depends where you are, the choices vary depending on availability. Plus, HA can be dissolved if needed.

I love using Perlane L or Radiesse in these areas.

Sculptra is also great,knowledge of anatomy is key and will yield the assurance of safe ,pleasing outcomes.There will always be risk.

Wllkinson, I got scared from SubQ, let me tell you. It was many years ago when SubQ first launched in the market, a training doctor from the company visited me in my practice to show the way of treatment.. We worked in the mouth to fill the cheek bones, he did the right side and finished in 10 minutes and I did the left side of the patient in half an hour, very carefully and slowly.. Patient left with some pain and swelling for sure he prescribed her some medicine to prevent swelling and kill the pain.. I asked her to visit me in every two weeks to follow up. After 2 months, she came back with necrosis on the right side.. I really got shocked.. It was the trainer's side. It was a very bad trial and until now I never use SubQ. In general I do not like to fill cheek bones inside the mouth since it is a very sensitive area.

I was discussing temporal hollows. I agree, intra oral cannula technique is prone to infection. I don't think it's the SubQ though. Could be any H.A and you might get an infection. It is mostly the technique than the product.

Yes. The intraoral approach seems to be popular with some plastic surgeons. Always a risk for introducing oral flora into the tissues. Mind you any deep filler is susceptible to biofilm infection. SubQ got some press about that a few years ago but theoretically I can't see why Voluma or Radiesse would not be subject to the same concerns. On the other hand, it's unorthodox to fill temporal hollows through an intraoral approach! Perhaps through the subzygomatic area and infra temporal fossa and a long cannula!?

If injecting cheekbones through the mouth, always ensure the patient rinses out with a chlorhexidine mouthwash just prior to the injection. I personally prefer an extra-oral approach .

PRP and Voluma can be very nice in this area but if using Voluma or another HA then I would always suggest a cannula.

PRP with 50/50 Hyaluronic Acid cross linked dilution. You can also use Sculptra or any HA for that matter but use the one that you can handle with utmost experience.