Dr. Gal Aharonov Facial Plastic Surgery Blog

Facial Plastic Surgery Blog by Dr. Gal Aharonov

Archive for the ‘Temples’ Category

Importance of temples in facial rejuvenation:

Friday, January 11th, 2013

One of the most over neglected and under appreciated parts of the face when it comes to facial rejuvenation are the temples. As we age, the temples tend to narrow and hollow out, shifting the balance of the face downward towards the mouth and lower cheeks. This gives our cheeks the appearance of it drooping and sagging and changes the harmony of our face. Injecting either filler or fat into the temples is a quick and simple way to give the face a more youthful harmony. Carefully examine your old photos when you were younger and pay close attention to the width of the temples compared to now. It is possible to pick up subtle differences even in your 20's.

Temple rejuvenation usually goes hand in hand with both upper eyelid and brow rejuvenation as well as with cheek rejuvenation. It is important to keep these structures well balanced and in harmony with one another otherwise treatments can look unnatural and fake.

I have very large cheek bones and hollow temples. I look like I have cheek implants even though I don’t! Is ther eany way to shave down the cheek bones so they are not as wide?

Wednesday, June 13th, 2012

It would be extremely unsafe to shave down your cheek bones so your face is less wide. There are many crucial nerves that would be in danger in that area. If you have hollow temples the safest thing would be to fill in your temples. This will bring your cheeks into greater balance and your cheeks will not appear to be as wide.

The easiest way to add volume to the temples is with filler. Juvederm can be used to fill the temples in quickly and easily with minimal downtime or bruising. Sculptra can also be used in the temple but tends to take months and months to show a noticeable difference. Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face.

I have lost over 70 lbs since last year and have noticed that my face has gotten really gaunt and hollow, especially my temples. Is it safe to put filler in the temples?

Monday, January 9th, 2012

Temples are actually one of the best places to put filler since it seems to last an extra long time in this part of the face. There are several filler options in the temples. These include Juvederm, Radiesse, and Sculptra. Each has its own unique advantages and disadvantages. I have seen filler last well over 2 years in this part of the face, but I advise patients that they might have to come about once a year for a slight top off. As for how much filler you might need, well, that depends on how hollow you are. On average patients tend to need at least half a syringe of filler to an entire syringe of filler PER temple. Sometimes more if there is significant hollowing. Usually I can estimate before hand about how much filler it will take.

Fat injections are another way to fill in hollow temples, but this is probably best for patients who need a significant amount of filling of their entire face.

I had a facelift 2 years ago and the surgeon left me with a scar in my temple right in front of my hairline. It also distorted the shape of my hairline. The scar is white and noticable! What can I do?

Wednesday, December 28th, 2011

Some surgeons use an incision in front of the hairline in the temple region. This can sometimes leave a noticeable scar especially if your skin color is not very pale white. Sometimes this also distorts the shape of the hairline in the temple region. Even if the scar healed well it could still be noticeable in this region. This same kind of problem can arise after a temporal brow lift if the incision was not placed correctly.

A scar revision is not always the best solution to solve this problem. Because hair bearing scalp might have been excised during the surgery, the shape of the hairline might be distorted. There are several other options that can be used to address this problem.

The first and simplest is especially useful in patients who have a pale scar with darker skin. The color contrast between the scar and normal skin is a big contributor to it being noticeable. Permanent tattoo makeup can be used to place pigment into the scar and reduce the contrast with the skin.

The second option is to use hair grafting to reshape the hairline and to add hair in front of the scar. As the hair grows in the scar will be more hidden inside the hairline.

I had a laser treatment on my face two year ago. I feel that my eyelids have become significantly more hollow since. Is it possible that the laser treatment caused fat loss around my eyes?

Wednesday, November 23rd, 2011

Although it has yet to be proven that certain laser treatments can accelerate facial volume loss, anecdotal evidence shows that especially around delicate thin skin such as around the eyes and temples lasers might accelerate facial volume loss. It is normal to lose facial fat with the normal aging process so it would be hard to tell what is truly causing the facial volume lose or the loss of fat round your eyes. Unless there is a controlled trial where a laser was only used on one half of the face we might never know!

People with orbital fat loss or hollowing around the eyes usually state that their eyes actually look better when they wake up in the morning and they are puffy. As the day progressed they state that they eyes look worse and more tired and hollow.

It is possible to address this orbital volume loss and hollowness with injections of either fat or fillers.

I had fat transfer to the whole face, including the temples and now my small eyes look even smaller. Should I consider having fat taken back out of the temples to adjust the ratios? It seems to be an area sensitive to surgery.

Friday, November 11th, 2011

Unfortunately once fat has been placed it is extremely difficult to try to remove. Sometimes too much volume in the temples and around the eyes can make the eyes seem smaller and more deep set. At times that is desirable especially for patients with bulging eyes or prominent eyes.

At times steroids or 5-FU can be injected judiciously to help reduce some of the fat volume but it is difficult and not very predictable. That is why it is always safer to underfill when it comes to fat or even fillers for that matter. It is always easier to put more in than to remove what's there.

I have always had big cheeks with high cheek bones. It looked great when I was young. Now I am 40 and relatively thin but my cheek bones seem to have gotten larger and more obvious. People keep asking me if I had cheek implants. Should I have my cheeks shaved down?

Thursday, August 11th, 2011

Thinner people with high cheek bones age with their cheeks looking more and more obvious in proportion to the rest of their face. When you are young there is more facial fat and padding around the cheek bones, in the temple, and in the submallar area (area below your cheek bone). As we age we slowly lose the fat and padding in our face: our temple become more hollow, we lose fat under our cheek bone, and our skin becomes thinner. Imagine having a rock under a thick comforter... It is difficult to see the edges of the rock under there. As we age that thick comforter turns to a thinner sheet and now all of a sudden you can see the outline of the rock. That is sort of what the cheek bone is like in people who have high cheek bones. this does not happen in people who's cheeks are mostly composed of fat. Those people end up with flatter cheeks as they age.

The treatment for you is not to shave down your cheek bones, which would be dangerous. The treatment is to add volume around the cheek bone--add padding like a thicker comforter. Your temple can be filled out as can the area below your cheekbone. This will soften your look and make your face more like it used to be when you were younger.

Before and after facial fillers to treat large cheek bones.

Notice how this patient's natural cheeks seemed large and artificial before. Fillers where used to soften the look of her cheeks.

To learn more about facial fillers go to our liquid facelift and facial filler information page

By Gal Aharonov

As I am getting older my brow bone seems to become more prominant. Is it getting bigger? What can I do to fix it? Is it possible to shave it down?

Thursday, May 5th, 2011

It is not typical for our brow bone itself to get bigger as we age, but it does tend to look bigger and more prominent in some people. Why is that? Usually the reason is loss of fat around the bone including in our temples and the fat under the brow bone in our upper eyelid. As the padding around the bone goes away with age, the bone seems more prominent.

Is it possible to shave down the brow bone? It might be but I would not recommend it. Instead the way to fix this is by adding padding back again around the brow bone. Either by using filler or fat injections. By giving more volume to the temple, forehead, and/or upper eyelid, the brow bone will appear less prominent.

I lost a lot of weight and my face looks very hollow and sunken. I do not have much loose skin. What kind of options do I have that are non surgical?

Tuesday, August 31st, 2010

Hollowing of our facial features is a main contributor to looking older and more tired. This could happen due to weight loss, genetics, having a very low body fat composition, or certain diseases. There are several good options for someone with your issue:

Fillers: Fillers can be used to target the hollowing features. They can be directly injected and you see an immediate result. This group includes injectables like Restylane, Juvederm, and Perlane.

Collagen Stimulators: These include Sculptra and Radiesse. Sculptra is an injectable but is not a filler. It causes your body to build collagen in reaction to it. It slowly works over several weeks and has a very gradual effect. It is usually done gradually over 2 to 3 treatment sessions to achieve an optimal result. Radiesse is a hybrid between fillers and Sculptra. It has an immediate filling component which you will see right away, and a collagen stimulatory effect that is also gradual like Sculptra.

Fat Injections: Fat can be harvested from other parts of your body, purified, and then gently injected back into your face. This is closer to being a surgical procedure but can also be done with you awake in our treatment room.

I had filler injected into my cheeks 2 weeks ago at this dermatologist’s office. I have big cheeks now, but it almost looks weird, like my cheeks are too obvious. I have people asking me what I did to my cheeks. What can I do to make them look better?

Sunday, January 31st, 2010

Using filler in the cheeks is one of the most common uses for fillers. The problem is that even though the cheeks themselves might look good after the injections--and that's a big if-- your new cheeks might be out of balance and out of harmony with the rest of your face. For example, a person who has volume loss in the cheeks and thinks they need bigger cheeks has most likely lost volume in the temples, under eyes, and right below the cheek as well. If these issues are not corrected at the same time, your new cheeks will look out of proportion to the rest of your face and might look fake.

The key to using fillers, or fat, or any other facial cosmetic surgery is to achieve facial harmony and balance.

So what are your options? Well, if you truly just want your cheeks to go back to what they used to, you can maybe have the filler dissolved, as long as a hyaluronic acid based filler was used (like juvederm, restylane, perlane). Your other option is to fill in those other areas a bit to bring your face into greater balance and harmony. Just a little filler in your temple, or under eye area might all of a sudden make your face look great and balanced again.