One area that is a subconscious giveaway to aging is your temple. When the fat in the temple area leaves, you look more “skeletal” and older. It is also a likely culprit in the worsening of your eyebrow drooping, eyelid droop, and crows feet around the eyes.
Whenever I do facial fat transfer, I spend a fair amount of time adding volume back to the temple and brow areas.
This was an article in the December 2021 Aesthetic Surgery Journal “A New Target for Temple Volumization? An Anatomical and Ultrasound Guided Study of the Intermediate Temporal Fat Pad.”
This was a very technical article, on how we Plastic Surgeons focus on putting volume back in the deep and superficial areas, but we need to focus as well on the intermediate fat pad.
They studied the anatomy using ultrasound technology and injecting red dyed HA filler into the intermediate fat pad in 20 fresh cadavers. They then did a dissection to see the injection accuracy and document the anatomy.
What did they find?
The intermediate pad is between the superficial and deep layers of the deep temporal fascia. 90% of the injections were in the right zone when done under ultrasound guidance.
My thoughts?
I get they are saying to try to inject into the intermediate fat pad. It sounds lovely. In reality, I can’t imagine many injectors are going to buy an ultrasound machine to help guide them to this specific layer, particularly when the fat pad is small/hard to discern to begin with, and what is the issue with adding volume to all the layers? deep, intermediate, and superficial? The superficial is the toughest, as in thin skinned patients, it may show some irregularity.
Of note, they discuss how deep injection is better to avoid the superficial temporal artery branches, but you need more product to see a change when injected deep. Superficial injections they say are good because more change is seen for a given amount of product, but it is close to the blood vessels.
I inject this area usually with fat, which uses blunt cannulas, so arterial injection is less likely, but still a risk. Again, not sure what the true effect of this study is, other than to remind us that there are three layers we can inject into.