MR.

KONSTANTIN FRANK (Orcid ID : 0000-0001-6994-8877)

DR. ANDREAS NIKOLIS (Orcid ID : 0000-0002-2927-5564)
PROF. SEBASTIAN COTOFANA (Orcid ID : 0000-0001-7210-6566)
Accepted Article
Article type : Original Contribution

Full-Face Effects of Temporal Volumizing and Temporal Lifting Techniques

Gabriela Casabona M.D.,1 Konstantin Frank M.D.,2 Nicholas Moellhoff M.D.,2

Diana Gavril M.D.,3 Arthur Swift M.D.,4 David L. Freytag, 2 Antonia Kaiser, 2
Jeremy B. Green M.D.,5 Andreas Nikolis M.D., 6 Sebastian Cotofana M.D., Ph.D.7
1
Ocean Clinic, Marbella, Spain
2
Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
3
Private Practice, Cluj-Napoca, Romania
4
Westmount Institute of Plastic Surgery, Montreal, Quebec, Canada
5
Skin Associates of South Florida and Skin Research Institute, Coral Gables, FL, USA
6
Erevna Innovations Inc, Clinical Research Unit, Montreal, Quebec, Canada & Division of Plastic Surgery,
McGill University, Montreal, Quebec, Canada
7
Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

Author’s contributions: G.C., K.F., N.M., D.G., A.S., D.L.F., A.K., J.B.G., A.N. and S.C.

have made substantial contributions to conception and design, or acquisition of data, or

analysis and interpretation of data. G.C., K.F., N.M., D.G., A.S., D.L.F., A.K., J.B.G., A.N.

and S.C. have been involved in drafting the manuscript or revising it critically for important

intellectual content and given final approval of the version to be published. Each author has

participated sufficiently in the work to take public responsibility for appropriate portions of

the content and agreed to be accountable for all aspects of the work in ensuring that questions

related to the accuracy or integrity of any part of the work are appropriately investigated and

resolved.

Data availability: The data that support the findings of this study are available from the

corresponding author upon reasonable request.

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jocd.13728
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 Ethical Statement: This study (retrospective data analysis) was conducted in accordance with
Accepted Article
regional laws (Brazil) and good clinical practice. Patients unwilling to provide access to their

medical records were not included in this analysis.

Keywords: Temple, Soft tissue fillers, Temporal hollowing, Crows feet, Lower face volume,

Jawline contouring, Facial Anatomy

Running title: Full-Face effects of temporal volumizing and temporal lifting techniques

Author disclosure: The authors declared no potential conflicts of interest with respect to the

research, authorship, and publication of this article.

Funding: The authors received no financial support for the research, authorship, and

publication of this article.

Corresponding author:

Sebastian Cotofana MD, PhD, PhD

Associate Professor of Anatomy
Department of Clinical Anatomy
Mayo Clinic College of Medicine and Science, Mayo Clinic,
Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA
Email: cotofana.sebastian@mayo.edu

Abstract

Background:

Most injection techniques utilizing hyaluronic acid based soft tissue fillers have predictable

outcomes at the location injected. However, the temporal region has been identified to have

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 the potential to affect panfacial aesthetic improvements depending on the applied injection

technique.
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Material and Methods:

The medical records of 9 female and 5 male Caucasian patients with a mean age of 50.9 ±

11.9 years were retrospectively reviewed for the effects of these techniques: supraperiosteal,

interfascial, subdermal. Panfacial effects were evaluated by the semiquantitative assessment

of aesthetic scores for the temple volume, the temporal crest visibility, the lateral orbital rim

visibility, the position of the eyebrows, the severity of lateral canthal lines, the midfacial

volume and by the contour of the jawline.

Results:

The supraperiosteal injection technique had the greatest influence on improving the temporal

volume (25.0%), the temporal crest (33.3%) and the lateral orbital rim visibility (31.0%)

scales but had no effects in other facial regions. The interfascial injection technique revealed

good effects on improving temporal hollowing (23.3%) but had an even greater effect on the

crow’s feet (26.8%) and on the position of the eyebrow (33.3%). The subdermal injection

technique had its greatest effects in the lower face by improving the contour of the jawline

(26.8%) followed by the improvement of the lower cheek fullness scale (14.3%).

Conclusion:

Future injection algorithms could utilize all three injection techniques together as one multi-

layer injection approach with a tailored proportion of each technique based on the aesthetic

needs of the patient.

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 Introduction:

The number of soft tissue filler injections performed is constantly increasing, as these
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procedures beget predictable aesthetic effects to ameliorate the signs of facial aging.1–4 The

treatments are tailored based on patient’s needs, aesthetic indication, anatomic region

targeted and product selected.5–9 While most injectable filler treatments aim to increase local

volume in an aesthetic site of interest, the potential regional or pan-facial effects are often not

realized. One of the reasons is that the changes induced by most injectable treatments are

restricted to the targeted area. Another reason might be the limited knowledge of facial

regions that have the potential to cause panfacial effects if targeted properly.

A previous split-face interventional study by Casabona and colleagues reported on the

effects of injecting the medial aspect of the zygomatic arch on the medial midface.2 The

authors found that a significantly reduced amount of hyaluronic acid based filler material was

needed in the medial midface if the zygomatic area which is located lateral to the line of

ligaments is targeted first. The authors explained their observations by the pre-conditioning

effect of the lateral injection which resulted in a tensioning of the midfacial fascial layers.

Another study by Suwanchinda et al. reported that injecting the subdermal plane of

the posterior and superior temple resulted in a lifting effect of the lateral midface and of the

lower face including the jawline.9 The authors provided cadaveric evidence for their panfacial

lifting effect and stated that the fascial layered arrangement is responsible for the effects

observed.

Both studies provided plausible evidence that the lateral face and especially the

temporal region might have the potential to influence the middle and the lower face if

injected with hyaluronic acid based soft tissue fillers. There are, however, new injection

techniques for targeting the temple, and it is unclear whether the aforementioned panfacial

aesthetic improvements would be exhibited with these novel approaches.

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 The objective of this study is to test the panfacial effects of the three most commonly

performed temporal injection techniques to date: 1.) Supraperiosteal needle injection of the
Accepted Article
anterior temple, 2.) Interfascial cannula injection of the superior temple, 3.) Subdermal

cannula injection of the posterior temple. The panfacial effects will be evaluated by the

objective assessment of aesthetic scores for temple volume, temporal crest visibility, lateral

orbital rim visibility, eyebrow position, lateral canthal line severity, the midfacial volume and

by the contour of the jawline.

Material and Methods

Sample investigated

The medical records of 9 female and 5 male patients of Caucasian ethnic background

with a mean age of 50.9 ± 11.9 years were retrospectively reviewed for the purposes of this

study. Patient data were eligible for review if the following criteria were fulfilled: Treatment

for bilateral aesthetic temporal volume loss with minimally-invasive procedures, no

additional facial soft-tissue or neuromodulator treatment during the evaluation period,

complete post-treatment assessment scores, evaluation of the aesthetic outcome by

independent (the non-injecting) physicians and the patient themselves after the treatment.

This study (retrospective data analysis) was conducted in accordance with regional laws

(Brazil) and good clinical practice. Patients unwilling to provide access to their medical

records were not included in this analysis.

Parameters evaluated

The following eight aesthetic assessment scores were reviewed on images in patients’

medical records for the purposes of the study. The images relied on frontal, 45 degrees lateral

and direct lateral view. After each technique the same five images were captured. The images

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 were evaluated retrospectively by the treating physician and by an independent observer with

experience in aesthetic medicine:

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1.) Temple hollowing scale ranging from 0 (= convex, rounded temple) to 4 (= severe,

deeply recessed temple)10

2.) Temporal crest visibility ranging from 1 (= no visibility) to 3 (= skeletonized

appearance)

3.) Lateral orbital margin visibility ranging from 1 (= no visibility) to 3 (= skeletonized

appearance)

4.) Brow position grading scale ranging from 0 (= youthful, refreshed look) to 4 (= flat

eyebrow with barely any arch)11

5.) Crow’s feet grading scale ranging from 0 (= no wrinkles) to 4 (= very severe

wrinkles)12

6.) Lower cheek fullness scale ranging from 0 (= full lower cheek) to 4 (= very severely

sunken lower cheek)13

7.) Jawline contouring scale ranging from 0 (= no sagging) to 4 (= very severe sagging)14

8.) Global aesthetic improvement scale (GAIS) was assessed 4 week after the last

treatment with values ranging from 1 (= exceptional improvement) to 5 (= worsened

patient). The evaluation of the GAIS relied on the assessment by the patient and by

two independent observers.15

Injection procedures performed

Three different injection techniques were performed during the same treatment

session following the same injection sequence. Each technique utilized 1.0 cc of hyaluronic

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 acid based soft tissue filler product (Juvederm Voluma, Allergan, Dublin, Ireland) applying a

total of 3.0 cc per side and patient.

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1.) Supraperiosteal bolus injection into the anterior temple following the “one up and one

over” injection algorithm. 16

A 23G 27 mm needle (BD, Franklin Lakes, New Jersey,

United States) was used.

2.) Inter-fascial injection into the loose areolar tissue located between the superficial and

the deep temporal fascia utilizing a 22G 70 mm blunt tip cannula (Softfill, Paris,

France). Cutaneous access was 0.5 cm medial to the temporal crest in the forehead at

the level of the most superior horizontal forehead line (when assessed upon

frowning). Upon skin penetration and periosteal contact, the cannula was angled

parallel to the bone and advanced into the temple gliding on the deep temporal fascia.

The product was distributed in equal small boluses across the superior temple.

3.) Subdermal temporal lifting technique injecting the product into the subdermal

superficial fatty layer utilizing a 22G 70 mm blunt tip cannula (Softfill, Paris, France).

Cutaneous access was at the midportion of the zygomatic arch and the cannula was

advanced oblique and posterior behind the hairline. Upon insertion of the total length

of the cannula a bolus of the product was applied without post-injection massaging.

Analytic procedure

All scores were assessed retrospectively on previously recorded images that were

included in each patient’s medical record. The numerical values of each score and for each

treatment were documented in a blinded evaluation sheet. Non-parametric testing was

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 conducted using SPSS Statistics 26 (IBM, Armonk, NY, USA) and differences were

considered statistically significant at a probability level of ≤ 0.05 to guide conclusions.

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Results:

Global Aesthetic Improvement Scale (GAIS)(Figure 1,2)

The images used for the assessment of the GAIS were taken four weeks after the last

treatment and were evaluated by the patient and by two independent observers. The mean

value was 1.07 ± 0.27 when assessed by the patient and was 1.39 ± 0.45 when assessed by

the independent observers. Patients rated their injection related outcome four weeks after the

procedure statistically significantly better than the independent observers with p = 0.005. No

adverse events related to the injection procedure were documented.

Supraperiosteal injections into the anterior temple (Table 1&2, Figure 3,4)

Performing the deep supraperiosteal product application in the anterior temple

resulted in a statistically significant improvement of the temporal volume scale by 1.00 ± 0.0

(p < 0.001 when compared to baseline), in an improvement of the temporal crest visibility by

1.00 ± 0.56 (p = 0.001 when compared to baseline), and in an improvement of the lateral

orbital rim visibility by 0.93 ± 0.62 (p < 0.001 when compared to baseline). No changes in

any of other scores were observed.

Inter-fascial injection in the superior temple (Table 1&2)

Injections between the superficial and the deep temporal fascia resulted in a

statistically significant improvement of the temple hollowing scale by 0.93 ± 0.50 (p =

0.001), in an improvement of the brow position grading scale by 1.29 ± 0.47 (p = 0.001) and

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 in an improvement of the lower cheek fullness scale by 0.57 ± 0.51 (p = 0.005). A slight but

not statistically meaningful improvement was observed in the temporal crest visibility by
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0.14 ± 0.86 (p = 0.527). No changes were observed in the lateral orbital margin visibility and

in the jawline contouring scale.

Subdermal temporal lifting technique in the posterior temple (Table 1&2)

Injection of the product into the superficial fatty layer of the posterior temple resulted in a

statistically significant improvement of the jawline contouring scale by 1.07 ± 0.27 (p <

0.001) and of the lower cheek fullness scale by 0.57 ± 0.51 (p = 0.005). A slight

improvement was observed in the temple hollowing scale by 0.36 ± 0.63 (p = 0.059) and of

the temporal crest visibility by 0.43 ± 0.65 (p = 0.034). Changes in the lateral orbital margin

visibility (0.14 ± 0.36 (p = 0.157)) and in the crow’s feet grading scale by (0.07 ± 0.27 (p =

0.317)) failed to reach meaningful statistical difference. No changes were observed in the

brow position grading scale.

Discussion:

The results of this retrospective image analysis confirmed the exceptional role of

temporal soft tissue filler injections for aesthetic facial treatments. In summary, the temples

of n = 14 patients were treated with a total amount of 3.0 cc per side, utilizing three different

injection techniques following the same sequence: 1.) Supraperiosteal needle injection of the

anterior temple, 2.) Interfascial cannula injection of the anterior temple, 3.) Subdermal

cannula injection of the posterior superior temple. Assessment scores were evaluated on

images by the treating physician and by an independent observer whereas the aesthetic

improvement four weeks after the last treatment was assessed by the treated patient and by

two independent observers based on retrospective image analysis.

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 A strength of the present study is the semi quantitative assessment of the treatment

outcome which was evaluated by various scoring systems assessing different facial regions.
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The primary treatment goal was the correction of the temporal volume, which was the

indication for the inclusion into this treatment algorithm. The anatomic regions in closest

proximity to the temple were assessed in a next step including the temporal crest and the

lateral orbital rim. The adjacent anatomic regions like the forehead, the periorbital region and

the lateral midface were assessed subsequently. Here, the brow position grading scale, the

crow’s feet grading scale and the lower cheek fullness scale were evaluated. In a further step

of assessment, an anatomic region not adjacent to the treatment area was assessed: the

jawline contour. Evaluating each of the scores after each injection procedure, allows for the

objective analysis of the local, regional and panfacial influence of the three different temporal

injection techniques. Another strength of this study is that the same volume and the same

type (brand) of hyaluronic acid was utilized for each injection technique.

A limitation to this evaluation procedure is that the effect of the second and third

injection i.e. interfascial and subdermal was not analysed individually. These two techniques

were preceded by the supraperiosteal injection, indicating that the interfascial technique

evaluation assessed both the supraperiosteal and the interfascial techniques together whereas

the third evaluation step analysed supraperiosteal, interfascial and subdermal together.

However, other prospective study design would also engender limitations. The individual

assessment via a split-face study design might leave the patient with a different treatment

outcome per facial side if two techniques are compared. If two techniques are utilized per

side in opposite sequences, one would be unable to assess the third technique. Additionally,

measured differences between treatment methods or injection algorithms could be attributed

to inter-individual differences and sample size variation which will bias the results and skew

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 data interpretation. To account for multiple assessments of injection step two and three, the

relative percent for each technique were calculated and presented in Figure 5.
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The results of this retrospective image analysis reveal that the supraperiosteal

injection technique had the greatest influence on improving the temporal volume, the

temporal crest and the lateral orbital rim visibility scales with 25.0%, 33.3% and 31.0%

respectively when compared to the other techniques. No effects in adjacent or other anatomic

regions were observed. From an anatomic perspective this is plausible as this technique

administers the product deep to the deep temporal fascia. This fascia covers the temporal

fossa tightly and is strongly adherent to the temporal crest and to the lateral orbital rim8 ; this

limits aesthetic effects to the temporal fossa. This resulted in the observed increase of the

respective local assessment scores.

Analysing the effects of the interfascial injection technique revealed that this approach

improved temporal hollowing (23.3%) but had an even greater impact on the crow’s feet

(26.8%) and on the position of the eyebrow (32.3%). Additional, but smaller effects were

observed in the midface (14.3%) and in the visibility of the temporal crest (4.7%) but not in

the visibility of the lateral orbital rim (0.0%). From an anatomic perspective this is plausible

because the product was administered superficial to the deep temporal fascia and can thus

influence the position and/or tension of the overlying superficial temporal fascia. The

superficial temporal fascia is continuous with the frontalis muscle and its over- and

underlying fasciae, is continuous with the orbicularis oculi muscle and is continuous with the

midfacial superficial musculo-aponeurotic system (SMAS).8 Age-related loss of tension of

the superficial temporal fascia can present as temporal hollowing (inclusion criteria into this

retrospective data analysis). Increasing the tension of the superficial temporal fascia can

influence the position of the eyebrow as it is at a muscular balance between eyebrow

elevators and depressors 17–19

and can reduce the severity of crow’s feet (aka lateral canthal

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 lines). The latter are static rhytides produced over time by repetitive contraction of the

orbicularis oculi muscle, which have been shown to improve if the tension of the superficial
Accepted Article
temporal fascia is restored.

The subdermal product placement in the superior and posterior temple had its greatest

effect in the lower face by improving the contour of the jawline by 26.8% followed by the

lateral midface where the lower cheek fullness scale was improved by 14.3%. Slight

influences were detected in all of the other scores except in the visibility of the lateral orbital

rim. This evaluation reveals that the subdermal injection technique can induce aesthetic

effects beyond the temple and into the lower face, which is confirmatory with previous

publications.2,9 From an anatomic perspective this is conceivable as the product is injected

superficial to the superficial temporal fascia and into the subdermal fatty layer with its

respective superficial inferior temporal fat compartment. It was confirmed by previous

reports that this fat compartment (along with the superficial superior temporal fat

compartment) does not descend with increasing age but is stable independent of how much

product is injected.20 This fact is utilized by this specific injection technique and it can be

hypothesized that the presence of the retinacula cutis and zygomatic adhesions serve as

leverage to reposition the midfacial and lower face soft tissues once the posterior and

superior temporal volume is increased. Due to the design of this retrospective review

however, it is unclear whether the calculated effects of the latter two techniques would be

similar had the supraperiosteal injections not been performed first.

Comparing the three different injection techniques for their cumulative relative

percent contribution to each score, the interfascial injection technique was identified to have

the best overall contribution with 101.2%, versus 89.3% supraperiosteal, and 70.5%

subdermal. However, each technique has its strengths and weaknesses, and injectors should

tailor their approaches to the patient’s aesthetic needs considering the rheology and safety

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 profile of the hyaluronic acid filler material, as well as the desired target anatomic layer. It is

unclear whether the effects documented herein would have varied if each technique would
Accepted Article
have been applied by itself and whether the observed effects are not influenced or pre-

conditioned by the previously injected material. Future studies could include larger numbers

of patients injected with these techniques in different orders to expand upon the presented

results.

Conclusion:

Future injection algorithms could utilize all three injection techniques together in as

one multi-layer injection approach with a tailored proportion of each technique based on the

aesthetic needs of the patient. Patients with a greater volume deficiency might receive more

product via the supraperiosteal technique whereas patients with the need for midfacial and

lower face lifting might receive relatively more product via the subdermal injection technique

administered into the posterior superior temple.

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 References

1. Surgery TAS for AP, TheAmericanSocietyForAestheticPlasticSurgery. Cosmetic

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(Aesthetic) Surgery National Data Bank Statistics.

https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf. Published 2018.

Accessed February 7, 2020.

2. Casabona G, Frank K, Koban KC, et al. Lifting vs volumizing-The difference in facial

minimally invasive procedures when respecting the line of ligaments. J Cosmet

Dermatol. August 2019. doi:10.1111/jocd.13089

3. Freytag DL, Frank K, Haidar R, et al. Facial Safe Zones for Soft Tissue Filler

Injections: A Practical Guide. J Drugs Dermatol. 2019;18(9):896-902.

4. Ghannam S, Sattler S, Frank K, et al. Treating the Lips and Its Anatomical Correlate in

Respect to Vascular Compromise. Facial Plast Surg. 2019;35(02):193-203.

doi:10.1055/s-0039-1683856

5. Yano T, Okazaki M, Yamaguchi K, Akita K. Anatomy of the middle temporal vein:

Implications for skull-base and craniofacial reconstruction using free flaps. Plast

Reconstr Surg. 2014;134(1):92e-101e. doi:10.1097/PRS.0000000000000283

6. Cotofana S, Schenck TL, Trevidic P, et al. Midface: Clinical Anatomy and Regional

Approaches with Injectable Fillers. Plast Reconstr Surg. 2015;136:219S-234S.

doi:10.1097/PRS.0000000000001837

7. Sykes JM, Cotofana S, Trevidic P, et al. Upper Face: Clinical Anatomy and Regional

Approaches with Injectable Fillers. Plast Reconstr Surg. 2015;136(5 Suppl):204S-

218S. doi:10.1097/PRS.0000000000001830

8. Cotofana S, Lachman N. Anatomy of the Facial Fat Compartments and their

Relevance in Aesthetic Surgery. JDDG J der Dtsch Dermatologischen Gesellschaft.

2019;17(4):399-413. doi:10.1111/ddg.13737

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 9. Suwanchinda A, Webb KL, Rudolph C, et al. The posterior temporal supraSMAS

minimally invasive lifting technique using soft-tissue fillers. J Cosmet Dermatol.

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2018;17(4):617-624. doi:10.1111/jocd.12722

10. Carruthers J, Jones D, Hardas B, et al. Development and Validation of a Photonumeric

Scale for Evaluation of Volume Deficit of the Temple. Dermatol Surg. 2016;42 Suppl

1(Suppl 1):S203-S210. doi:10.1097/DSS.0000000000000848

11. Carruthers A, Carruthers J, Hardas B, et al. A validated brow positioning grading

scale. Dermatologic Surg. 2008;34(SUPPL. 2). doi:10.1111/j.1524-4725.2008.34363.x

12. Carruthers A, Carruthers J, Hardas B, et al. A validated grading scale for crow’s feet.

Dermatologic Surg. 2008;34(SUPPL. 2). doi:10.1111/j.1524-4725.2008.34367.x

13. Carruthers J, Flynn TC, Geister TL, et al. Validated assessment scales for the mid face.

Dermatologic Surg. 2012;38(2 PART 2):320-332. doi:10.1111/j.1524-

4725.2011.02251.x

14. Narins RS, Carruthers J, Flynn TC, et al. Validated assessment scales for the lower

face. Dermatologic Surg. 2012;38(2 PART 2):333-342. doi:10.1111/j.1524-

4725.2011.02247.x

15. Vandeputte J. Real-world Experience with Volume Augmentation using Cohesive

Polydensified Matrix Hyaluronic Acid Gel: A Retrospective Single-center Analysis of

110 Consecutive Patients with Medium- to Long-term Follow-up. J Clin Aesthet

Dermatol. 2018;11(12):30.

16. Swift A, Remington K. BeautiPHIcationTM: A Global Approach to Facial Beauty. Clin

Plast Surg. 2011;38(3):347-377. doi:10.1016/j.cps.2011.03.012

17. Moqadam M, Frank K, Handayan C, et al. Understanding the shape of forehead lines.

J Drugs Dermatology. 2017;16(5).

18. Frank K, Freytag DL, Schenck TL, et al. Relationship between forehead motion and

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 the shape of forehead lines-A 3D skin displacement vector analysis. J Cosmet

Dermatol. July 2019. doi:10.1111/jocd.13065

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19. Cotofana S, Freytag DL, Frank K, et al. The Bi-Directional Movement of the Frontalis

Muscle - Introducing the Line of Convergence and its Potential Clinical Relevance.

Plast Reconstr Surg. February 2020. doi:10.1097/PRS.0000000000006756

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2018;141(6):1351-1359. doi:10.1097/PRS.0000000000004364

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 Figures:

Figure 1: Pre- and post treatment images (frontal view) of a female study participant. Note
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the temporal volume increase after the three different techniques were applied.

Figure 2: Pre- and post treatment images (right oblique view) of a female study participant.

Note the temporal volume increase after the three different techniques were applied.

Figure 3: 3-Dimensional photograph of one treated female patient with superimposed colored

skin vector displacement showing the movement of the skin. Note that the vectors are

pointing toward the temple.

Figure 4: Cartesian coordinate system analyses of the skin vector displacement displayed in

figure 1. Here the overall amount of skin displacement in horizontal (= x-axis) and vertical

(y-axis) axes of the lateral face was calculated to be 0.46 mm for both facial sides.

Figure 5: Bar graph showing the increase in relative percent (adjusted for each score) after

each performed injection technique for each of the assessed facial scores.

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 Table 1: Absolute values for each of the assessed scores at baseline and after each performed
injection procedure for the n = 14 treated patients

Score before Score after Score after Score after

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N = 20 treatments supraperiosteal treatment interfascial treatment subdermal treatment
mean (SD) mean (SD) mean (SD) mean (SD)
Temple hollowing scale
3.14 (0.54) 2.14 (0.54) 1.21 (0.43) 0.86 (0.36)
(0 - 4; best to worst)
Temporal crest visibility
2.57 (0.51) 1.57 (0.76) 1.43 (0.65) 1.0 (0.0)
(1 - 3; best to worst)
Lateral orbital rim visibility
2.07 (0.62) 1.14 (0.36) 1.14 (0.36) 1.0 (0.0)
(1 - 3; best to worst)
Brow position grading scale
2.43 (0.65) 2.43 (0.65) 1.14 (0.36) 1.14 (0.36)
(0 - 4; best to worst)
Crow’s feet grading scale
1.57 (0.85) 1.57 (0.85) 0.50 (0.65) 0.43 (0.65)
(0 - 4; best to worst)
Lower cheek fullness scale
1.71 (0.91) 1.71 (0.91) 1.14 (0.95) 0.57 (0.85)
(0 - 4; best to worst)
Jawline contouring scale
1.86 (1.10) 1.86 (1.10) 1.86 (1.10) 0.79 (0.98)
(0 - 4; best to worst)

Table 2: Absolute percent values normalized to each score at baseline and after each
performed injection procedure for the n = 14 treated patients.

Score after Score after Score after

Score before
supraperiosteal interfascial subdermal
treatments
N = 20 treatment treatment treatment
Absolute percent
Absolute Absolute Absolute
(%)
percent (%) percent (%) percent (%)
Temple hollowing
21.5 46.5 69.8 78.5
scale
Temporal crest
14.3 47.7 52.3 66.7
visibility
Lateral orbital rim
31.0 62.0 62.0 66.7
visibility
Brow position
39.3 39.3 71.5 71.5
grading scale
Crow’s feet grading
60.8 60.8 87.5 89.3
scale
Lower cheek fullness
57.3 57.3 71.5 85.8
scale
Jawline contouring
53.5 53.5 53.5 80.3
scale

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Accepted Article

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Accepted Article

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Accepted Article

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