Let me take you into the consultation room, where a thoughtful conversation is about to unfold. A hypnotherapist named Gabriella has come in seeking harmony—not just in her features, but in the way her face tells her story. She’s had treatments before: rhinoplasty, a little lip filler, some Botox. But today, she’s after something more intentional: balance. She feels one side of her nose has a bumpy, uneven contour while the other runs straight. Her top lip, she believes, is thinner than her bottom lip, and she longs for symmetry and a natural look. She also mentions considering a bit of filler under her eyes.
Before any needle meets skin, there is a careful dance of assessment and trust. Medical history has been discussed, consent given, risks explained. Now comes the face itself—a landscape to be read, understood, and gently reshaped. The first thing we notice is the radiant skin. The upper third of the face—from hairline to glabella—shows excellent symmetry. The middle third, however, begins to reveal the story: the nose is where symmetry starts to waver. The lower third is balanced, but there is room to refine its proportions. On profile, all features project equally: the chin, crease, lips, nasolabial angle, and nose create a pleasing line. There is no significant dorsal hump, and the upper face has a lovely, rounded youthfulness.
Yet, the eyes see what others might miss. In the early 40s, volume loss begins to show in characteristic areas—most notably, the temples. A subtle hollowness has crept in. The cheekbones are striking, but a gentle enhancement would make them even more prominent. If we add volume to the temples, the lateral cheek fat, and the medial midface in sequence, the effect would be stunning. Around the eyes, there is no hollowing above, but when Gabriella looks upward, shadows appear beneath—a classic indication for tear trough treatment. The nose itself has an irregularity on its dorsum; filler can smooth that out, and a little lift to the cartilaginous tip would improve the profile, helping the nose point forward instead of downward.
Now we come to the lower third. One of the most telling observations is the elongated upper lip. In a feminine face, the ideal proportion is one-third upper lip to two-thirds lower lip. Here, the gap between the nose and upper lip is a bit wide. By increasing the vertical height of the upper lip, we feminize the lower third. And with a little projection at the apex of the chin, we create continuity from the gonial angle all the way to the front of the chin. No work is needed at the jaw or mandibular border—they are already in fantastic condition.
This is not a one-area treatment. This is a full-face approach using filler at different depths and in different areas. The secret lies in the sequencing. Follow the principles: start from the top of the face and work down. Start from the lateral face and work medial. Start deep and work superficial. That gives a clear algorithm: temples first, then midface, then nose, then under-eye hollows, and finally the lips.
So we begin with the temples. But how do we choose the technique? Each method has a different effect. If the goal is lifting the tail of the brow, we want a technique that goes beneath layer three of the temple—like the periosteal or interfascial techniques. For a broad, diffuse area of volume loss, the submuscular technique works well. In Gabriella’s case, we have a midsized area of volume loss and we want to support the brow tail and midface. The ideal technique is the interfacial approach.
We identify key landmarks: the temporal crest, the lateral orbital margin, and the superior border of the zygomatic arch. The visible portion of the temporal fossa lies anterior to the hairline. Our entry point is from the forehead, because the plane beneath the frontalis muscle is continuous with layer four in the temple. This is a critical anatomical insight: the interfascial space sits between the superficial temporal fascia (layer three) and the deep temporal fascia. This plane is safe for injection because it does not contain any arteries. However, it does contain the facial nerve and the sentinel vein. A lacerated vein can cause a deep, painful hematoma, so we proceed with steady, gentle control.
We use a 22-gauge cannula and a projecting filler like Revanesse Contour. The cannula passes through skin, through the frontalis muscle, over the temporal crest, and into the interfacial plane. This plane is normally closed, so we open it with slow, controlled anterograde and retrograde movements. We fan into the space, always aware of the superficial temporal artery, which we palpated earlier. On one side, the artery pulses right in the middle of the fossa, so we enter beneath it, making bony contact first. On the other side, the artery stays within the hairline, giving us more freedom.
Half a syringe into each temple—no pain at all. Instantly, we see the power of this treatment. The brow lifts. The lateral canthus of the eye appears higher. The jawline gets a subtle lift. The face gains a refreshed, balanced appearance. Surface veins may pop out from increased venous pressure, which almost always settles within a day. But the immediate result is clear: the temples are no longer hollow, and the entire face has been elevated in multiple dimensions.
And that is just the beginning. The midface awaits its turn, and then the nose, the tear troughs, and finally the lips—all guided by the same systematic, evidence-based approach. Each step builds upon the last, creating a harmonious whole that honors the natural anatomy and the patient’s unique story.