The Art of the Upper Face: A Story of Subtle Restoration and Safety
Let me tell you a story about the upper face—a place where the smallest adjustments can create the most profound transformation. It begins, as all good stories do, with listening. Consultation is the foundation, understanding what truly concerns the person before you, and then gently educating them on the root cause of what they see.
Consider a woman who came with frown lines—lines that had grown stubborn, resistant to Toxin. The truth was, she had long needed something else: volume underneath the glabella, a resource she'd once had many years ago with a different technique. When I directly treated those lines, she also mentioned needing temple volume replacement. But that's just the beginning of the story. When you look closely, after correcting the temples, you often notice the lateral frontal fat pad is also depleted. To achieve a smooth, continuous shape along the forehead, you must treat both the temple and the lateral frontal fat pad together. And sometimes, even the line that divides them—the shadow running along the temple crest—requires filling underneath and above to create one seamless, fluid contour. This is where the real artistry lies.
Now, I will share with you a lesson in treating a risky area in a way I believe is safe. It demands the use of a cannula, patience, and certain techniques to validate the cannula is not inside a vessel. Before I even started on the temple, I studied the risks. I used an ultrasound scanner, though I could not see an artery there. But I always use my finger as well. The ultrasound probe can be angled wrong, or a small vessel might be squashed and hidden from view, but your finger can often feel what the machine misses. I always do both. I felt for that transition where the shadow forms—my aesthetic goal—and then chose my entry point for the restoration.
I angle my cannula in a specific way. If I go too deep, I would enter an area I wish to avoid. The worst-case scenario: if I injected back here, just over the pterion—that suture point where the bones of the skull meet—I must remember its weakness. The pterion is thin, and it grows thinner with age. A needle could theoretically go straight through, introducing filler into the cranium. So I always inject in a manner that makes this impossible. My angle is directed up towards the frontalis. If I were to go deep, I would hit the frontal bone. The goal is only to kiss the bone and stop, but that extra layer of safety matters. After checking for vessels with my finger and seeing none, I clean the skin multiple times. Then I enter, touch the bone—which is not as deep as one might think—and perform a long aspiration. Movement after the aspirate is fine; I maintain negative pressure, which increases sensitivity to any intravascular placement. I close off slowly. There's nothing wrong with moving the needle a millimeter here or there, repeating the aspiration, to reduce the risk of a large bolus injection.
I touched the bone, and the needle is now a little blunt—even from a single touch. I can hear that noise, so I will not come in and out again. I massage lightly. It looks good. The area is leveled; there is no outward curve—I want a flat area. But I now see an opportunity above to improve the lateral frontal fat pad. Often, correcting one area reveals the transition more clearly elsewhere. I will do that once the other side of the temple is complete.
I take a new needle. I feel again for any vessels. I aspirate, give it time, and slowly begin to inject. Another gentle massage. Now, I will do a tiny bit of airbrushing—a subtle contour change to create a more harmonious shift. It's not a distraction; it's super subtle. But if we are to make someone look fresher and younger, hiding the transition points between the temple, lateral forehead, and frontal eminence is one way to do it. This is a lot of what makeup actually does for people.
Once again, I feel for blood vessels. This is a deep injection. If you can reach the periosteum, using a cannula with the bevel facing downward is key. The trickiest part is finding your layer; once you're in, it's usually straightforward. There is an interesting place to treat where the corrugator inserts. You often get a little shadow caused by frowning that persists even after Toxin. A very small amount of product here can make someone look more relaxed. I edge my way in, relying on ease of movement. For an extra layer of safety, I compress where vessels might be.
Look at the reflection on the skin. The untreated side has more complexity, more clusters of light. The treated side looks more matte—not actually more matte, but spreading light in a consistent way, so you don't see those clusters. It already looks better. Just like makeup, but more than anything, it's about how the light behaves. We will now achieve the same result here by adding volume into this section.
The next area—the glabella—requires a slightly different entry point, as I cannot reach across it all. I go in lateral to the glabella. I am always thinking about the supraorbital nerve; I want to miss it, go underneath if possible. But one of my greatest defenses is simply being gentle and patient. I call these the analog variables—it is impossible to measure how much patience makes you safer, but it seems obvious. We will never have a randomized control trial for patience. I move freely, aspirate, compress any vessels, and inject while moving. I am also at a 90-degree angle to any vessels, which makes it far less likely to be inside one.
Before moving on to the rest of the face, I notice a small shadow, a little indentation that I cannot ignore. It is part of the temple, where we already injected, but it just needs a bit more volume. This is the story of the upper face—a narrative of careful observation, layered safety, and the quiet power of subtle, harmonious restoration. It is not about dramatic change; it is about making the light dance more gently across the skin, and helping someone see themselves as truly refreshed. And that is a beautiful ending.