The Art of Facial Filler: A Journey Through the Upper Face
Let me share with you something I've learned over countless hours of practice and study. The face is not just a canvas—it's a complex landscape of arteries, bones, and delicate tissues, each with its own story. When we talk about dermal fillers, we're not simply adding volume. We are navigating a living map, and every decision matters.
I want to take you on a journey from top to bottom, starting with the upper face. But first, imagine standing at the base of a mountain range. You can see the peaks, but you know the hidden valleys and streams are what truly shape the terrain. That's how I see the forehead.
The Forehead: Where Arteries Rise Like Rivers
There are four major arteries here that demand our respect: the supraorbital and supratrochlear arteries. They all emerge from the orbital rim—that bony ridge beneath your brows—and as they travel northward, they become more superficial. Think of them as rivers that start deep in a canyon and gradually flow to the surface.
Here's a critical insight: near the orbital rim, these arteries lie deep, below the 1.5 centimeter mark. But as they ascend toward the hairline, they rise. So if you are considering a needle injection in this region, I strongly recommend using ultrasound to see what lies beneath. That said, even the best textbooks offer guidelines, not guarantees. Medicine always involves a little gray area.
If you don't have ultrasound and you need to fill a hollowing right around that 1.5 centimeter depth, my go-to approach is a 22-gauge cannula, placed deep, riding right on the bone. Keep it oscillating, use small aliquots. This is a much safer way to navigate this terrain.
The Glabella: The No-Fly Zone with a Caveat
Now let us move to the glabella—that space between the brows where deep, stubborn lines often settle. Patients come in with years of frowning etched into their skin, lines that neuromodulators alone cannot soften. Dermal fillers can help, but there is a catch.
Those lines run parallel to the supratrochlear arteries, which can lead directly to the eye. Because of this, I have traditionally called this a no-fly zone. However, if you can mitigate risk by understanding the depth, you may proceed. At this location, the arteries hug the bone. They are nowhere near the surface. So you place the product into the skin, between the dermis and epidermis, perpendicular to these vessels, using micro-drops. Three ways to avoid injury: micro-drops, proper depth, and patience.
A technique I find effective is Dr. Tom Bennett's burning technique—small, precise deposits to soften these lines. But please, only attempt this if you are a skilled injector. And if you have ultrasound, use it. That extra level of safety is never wasted.
The Temple: Two Techniques for One Canvas
The temple is a large surface area, and it requires two different strategies. I prefer a combination approach.
First, the needle technique. Locate the temple crest—that bony ridge—then move one centimeter up and one centimeter down. Inject a high G' prime filler directly onto the bone here. I want volume and projection in this spot. Why? Because often, there are no arteries in that precise location. Still, I recommend ultrasound to confirm the area is avascular. The beauty of this injection point is that it kicks up the tail of the eyebrow for many of my clients, creating a beautiful lift.
Second, to cover the rest of the temple, I use a cannula with a low to mid G' prime filler. The cannula is safer by design—it bumps arteries out of the way and typically causes minimal bruising. By fanning the product throughout the remaining area, I achieve balanced volume without overfilling the base. This combination prevents headaches later—both literally and figuratively.
The Tear Trough: A Safe Haven in a Complex Zone
Now we arrive at the tear trough. Aesthetically, this is one of the most challenging areas to treat. But here is a paradox: it is actually one of the safer zones. Why? Because there are very few arteries nearby. The only significant one is the infraorbital foramen artery, which sits deep, right on the bone—and we are working in an entirely different area code.
When placing filler here, we want to deposit the product underneath the muscle. You can do this with a BD needle directly on bone, or with a cannula hugging the orbicularis retaining ligament. Either way, this approach prevents complications and yields beautiful results.
The Nose: The Most Controversial Territory
Finally, we come to the nose—one of the most debated areas in all of aesthetic medicine. Every textbook tells us that the dorsal nasal arteries run superficially and never deviate. Therefore, the logic goes, if you inject deeply down the midline, you will be safe.
But real life is not a textbook. In reality, these arteries can deviate. Sometimes they cross the midline. Sometimes they run deep. The real danger is when an artery does both—crosses the midline and runs deep—because if you are injecting deep into what you thought was a safe zone, you could cause a serious complication.
How do we avoid this? Three ways: use a cannula, use small aliquots so you never block an artery, or use ultrasound to confirm the area is safe. I personally prefer a small BD syringe placed deep down the midline, unless my ultrasound tells me otherwise. I choose a very high G' prime filler, something that mimics bone, to create a straightening illusion.
This is not a place for shortcuts. Extreme precautions are non-negotiable.
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Whether you are a practitioner or a curious soul, remember this: the face is a living map, not a static diagram. Every injection is a conversation with anatomy. Listen carefully, respect the terrain, and the results will speak for themselves.
Take care of yourselves. Exercise daily. And please, be kind to absolutely everyone.