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Rethinking Temple Filler Techniques

Where is the “safer” plane to inject a Temple?

What is the best technique to adopt depending on which layer you want to fill?

There is a lot of discussion about this lately.

With the newer research coming out of Ultrasound assisted filler placement, more and more providers are abandoning the Gunshot or “one up one over” technique for a more superficial approach with a large (22g), blunt tipped cannula.

Ongoing work suggests that the deep temporal artery may be present in the supraperiosteal plane EXACTLY AT THE ONE UP, ONE OVER INJECTION POINT in over 30% of patients.

As we can see from the second image, there are blood vessels in almost every plane. One of the most important vessels for consideration is the Superficial Temporal Artery found in layer 3 (the superficial temporal fascia).

While the supraperiosteal plane may be considered “avascular” in the majority of people, there are important vessels found in almost every layer above. If you truly understand the physics of Intravascular Occlusion, you know that one way product gets deposited into the lumen of a vessel is through retrograde arterial migration. This can lead to embolism, necrosis or the worst possible complication, blindness. A negative aspiration is no guarantee that product won’t move into a vessel during our injection or with the withdrawal of our needle.

I captured the above ultrasound image while scanning my good friend @leewalker_academy during our recent N2 Aesthetics Mastermind Retreat. His deep temporal artery was exactly at the one up one over position.

Personally, I only fill temples superficially with a 22g cannula.

The evolution of our techniques for both safety and better aesthetic outcomes are driving the future of aesthetic medicine. We cannot remain complacent because it’s what was always done…we are always learning and getting better.

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