Fillers are commonly used to revolumize the midface, cheeks and nasolabial folds. But less common areas also deserve attention, including the temple, infraorbital area and the back of the hands, according to Joel Cohen, M.D., Denver, Colo., who recently offered tips for filler treatments at Cosmetic Surgery Forum 2019 in Nashville, Tenn.
Importantly, Dr. Cohen points out that filler treatment of the temple and the infraorbital areas are both off label, while Radiesse (Merz) and Restylane Lyft (Galderma) are approved to restore volume to the back of the hands.
“I think these three areas have some similarities… the volume loss that happens over time can be quite significant,” says Dr. Cohen. And, he points out, choosing the best filler for these areas depends on how much volume, lift and contour are needed.
When injecting the temple, “I tend to inject about a centimeter and a half up from the orbital rim and about a centimeter over. I like to feel the needle really pass through that superficial temporal fascia and deep temporal fascia and really be down on bone — gently on bone — on the periosteum in that temporal fossa, and sort of gently lift up in that area,” he explains.
Dr. Cohen says he prefers to inject the temple with a needle rather than a cannula.
“I just don't feel like I can reliably feel the ability to get through those planes with a cannula,” he says, pointing out that the needle helps him be more confident he’s on the bone.
In the infraorbital area, however, he frequently uses a cannula, citing research that examines cannula size and safety. In short, a 27-gauge cannula or needle are more likely to enter a blood vessel than a 25-gauge cannula or larger.
“…using a 25-gauge cannula or something larger, like a 23- or 22-gauge cannula in some areas, in particular, the infraorbital area, or the dorsal hand or sometimes in the décolleté, can be helpful, and there is some data,” Dr. Cohen says.
1. Hexsel D, Soirefmann M, Porto MD, Siega C, Schilling-Souza J, Brum C. Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds. Dermatol Surg. 2012;38(2):207-14.