Augmentation of the upper third of the face is ideally done with a custom forehead implant design. In creating these designs one of its considerations is whether the augmentation should stop at the bony temporal line or does it need to extend onto the temporal muscle area at the side of the forehead. As a forehead augmentation that stops at the bony temporal lines can make the temples appear more narrow, some custom forehead implants may need to extend onto the deep temporal fascia particularly if the patient has a narrow head shape.
In some custom forehead patients any temporal hollowing concerns may be more modest in nature. In these cases it is best to not extend the implant design into the temporal area and do fat injections for the temporal augmentation instead. In doing fat injections at the same time as placement of the custom forehead implant it is important to keep the fat out of the subcutaneous fat layer. This avoids potential contamination into the implant pocket from fat extravasation.
Instead the fat should be injected below the deep temporal fascia into the muscle. This provides the necessary augmentation effect while avoiding any implant contamination from the fat. It may also provide a better tissue bed for improved fat survival.
Dr. Barry Eppley
World-Renowned Plastic Surgeon