There are a variety of methods of temporal augmentation including synthetic fillers, fat injections and implants. All of these methods have their advantages and disadvantage is but the only assured permanent method is with the use of a temporal implant. Temporal implants are unique facial implant as they are the only one that is not designed to augment the bone. Rather temporal implants are to augment the muscle as this is what makes up the area to the side of the bony orbits.
The placement of temporal implants requires a skin incision which can be placed in multiple areas around the temporal hairline. Most commonly the incision is placed 1 to 2 cm behind the temporal hairline in a vertical orientation that parallels the hair follicles. Other approaches include the more remote location from an incision behind the ear as well as the most direct location along the temporal hairline.
The direct hairline location is the least used method for placing temporal implants because of the potential scar. However, if a hairline scar already exists from a prior facelift procedure this makes the decision to use it obvious. The advantage of the hairline incision is that the sub fascial dissection is more limited and the edges of the implant after placement can be clearly seen. It is also a procedure that can be done under local anesthesia.
One other advantage of the direct hairline approach for temporal implants is that it can readily be combined with a temporal brow lift. The undermining to the tail of the brow bone is easily done along the fascia lining and the vector of the lift can be controlled by skin excision or skin edge transposition with suturing to the fascia. This joint temporal procedure is an excellent method for upper facial rejuvenation particularly in the patient with a more gaunt/aged appearance from temporal hollowing.
Dr. Barry Eppley
World-Renowned Plastic Surgeon