A Safer Way to the Temple: A Story of Precision and Care
I've sat in many an international conference, listening to top expert plastic surgeons and injectors declare that a certain technique is the very best way to restore a temple. And I can't help but think to myself, "That's the best way to cause blindness and congest the lymphatics." There is a better way. Let me share with you what I have found.
The journey to a safe, effective, and aesthetically superior result begins with a simple, three-part rationale for every single entry point I choose. First, I always ask: is this entry point truly safe? Am I running my cannula parallel to a major artery, or am I going perpendicular? When perpendicular is possible, that is the only direction I want to go. Second, will this placement give me aesthetically pleasing results immediately, and does it place me in an ergonomic position that I can sustain comfortably? Third, and perhaps most critically, will the product stay where I put it, or is there a strong chance it will migrate elsewhere in a few weeks, causing unwanted side effects? These three questions are my compass.
The Neck: Two Roads, One Destination
Let's start with the neck. I've learned two distinct techniques, and honestly, I like them both. Each is safe, provides great results, places me in an excellent ergonomic position, and keeps the product precisely where it belongs. Let me walk you through them, and you can test which resonates more with your own practice. For myself, I now favor the midline technique, but both are outstanding.
The first is a three-point technique. For the lateral neck, your entrance point is just medial to the sternocleidomastoid muscle, right in the midpoint of the area you wish to treat. With a long cannula, you can reach across the entire lateral aspect, coating it beautifully. You do the same on the opposite side. Then, for the submental region, you make your entrance point just underneath the chin. From there, your cannula works superficially, submentally, covering everything in between. As long as you remain superficial, you are safe. The major carotid arteries run deep; you are going perpendicular and staying on the surface. You will be fine.
The second technique, the one I have come to prefer, is the midline method. Your entry point for the submental area remains the same, just under the chin. But instead of starting laterally, you start directly in the middle. From this single point, you can reach all areas by turning your cannula each way. The real bonus here, however, is for the necklace lines—those tech neck lines. By placing your entrance point directly at these lines, you can go directly underneath them and prop them up, improving them simultaneously. It is a lovely, efficient bonus. Ergonomically, it works well, though you may need to move around your client a couple of times. Choose whichever best suits you, but remember, for advanced techniques like these, seek education from a knowledgeable provider.
The Forehead: Going with the Grain, Not Against It
Now, let's move to the forehead. Consider the anatomy: the temple crest, and then the supratrochlear and supraorbital arteries. Notice a critical pattern—they all run north, vertically. The last thing you ever want to do is inject parallel to them. Yet I see practitioners coming in from the sides, placing the cannula horizontally in a way that runs right alongside these vessels. For me, that is playing with fire. I will not do it.
Instead, I place my entry point right in the midline of the forehead. A wonderful benefit of this location is that most people have some hollowing directly across this area, and this entrance point gives me direct access to exactly that region. The key is to inject deep. When you place your introducer, make sure it is deep, down to the bone, underneath the galea aponeurotica. You want to be in that smooth gliding plane just on the bone. If you place your cannula there, you should not be able to tent the skin up. If you can tent it easily, you are in the subcutaneous plane. The problem with that is you will block the patient's movement, and every time they move, you will see a bulge of the product. Place it deep, everything looks natural and works perfectly, regardless of the patient's age. It is much safer, and you will love the result.
The Temple: A New Approach That Changes Everything
Finally, we arrive at the temple, a complex area fraught with risk. We have three major arteries to consider: the superficial temporal artery, which usually runs along the hairline and can anastomose with the supratrochlear artery, leading directly to the eye; and the two deep temporal arteries, one posterior and one more anterior. The cardinal rule: do not inject parallel with them.
When restoring the temple, the best bang for your buck is always restoring the deep temporal fat pad, also known as the interfascial technique. This fat pad is an extension of the buccal fat that starts here, goes underneath the zygoma, and continues there. Restoring it looks the most natural and will not congest the lymphatics, unlike coating the superficial fat pad. The anatomy has layers: skin, superficial fat pad, fascia, and just underneath that lies the deep temporal fat pad. The traditional way I was taught to access it is to go 1 cm below the temple crest, because the space above is too tight. But look at the path of the cannula—you are running parallel to all those major arteries. That is dangerous. Even a 22-gauge cannula can canulate an artery. And even if it doesn't, you are forced to create a second entrance point elsewhere to reach all the areas that need restoration. So the classic interfascial technique is both riskier and incomplete.
Because that technique is so tricky, many providers resort to a combination: a needle technique called "one up and one over" here, and then a cannula to coat the superficial fat pad. The problem is that the "one up and one over" area is often not avascular, as many believe. Using ultrasound, I have found an artery on bone in over 30% of my patients. I consider it too risky, even with aspiration. And then coating the superficial fat pad? That congested lymphatics, and the patient's veins throb with lidocaine and filler for two weeks or more. There is a better way.
This new technique is elegant and safe. You make your entrance point at the same location as the superficial fat pad technique, right here. But the temporalis muscle fibers all run in this direction. By entering here and going with the grain, it is actually easier to get deep. Your first goal is to feel two pops: the first through the subcutaneous layer, the second through the fascia. Now you are in the deep temporal fat pad. From this single entry point, you are going perpendicular to the arteries—a much safer proposition—and you can coat the entire area that needs deep restoration. 90% of your filling happens here, in the deep temporal fat pad. Then, you retract your cannula slightly and move more superficially into the superficial fat pad. All you do here is restore the tight spaces around the orbital rim and the temporal crest, tying it off perfectly. You save just a small amount of product for those areas. The result is that 90% of your product is exactly where you want it, deep and safe, and the rest finishes the look naturally. I have tried it, and it is terrific.
I hope these insights serve you well on your own journey. These are not techniques I invented; they are what I have learned, tested, and found to work best. Take care of yourselves, exercise daily, and please, be kind to absolutely everyone.