Original Research

Temporal Augmentation: A Systematic Review

Sammy Othman, BA1 Jason E. Cohn, DO2 Jacob Burdett, DO2 Srihari Daggumati, MD3
Jason D. Bloom, MD4

1 College of Medicine, Drexel University, Philadelphia, Pennsylvania Address for correspondence Sammy Othman, BA, Drexel University,
2 Department of Otolaryngology - Head and Neck Surgery, Philadelphia 2900 West Queen Lane Philadelphia, PA 19129
College of Osteopathic Medicine, Philadelphia, Pennsylvania (e-mail: sothman13@gmail.com).
3 Drexel University College of Medicine, Philadelphia, Pennsylvania
4 Facial Plastic Surgery, Main Line Center for Laser Surgery, Ardmore,
Pennsylvania
Facial Plast Surg

Abstract Clinicians employ various modalities in order to achieve temporal augmentation;

however, no literature comprehensively describes these methods or provides perspec-
tive on available options. Understanding the available methodologies for cosmetic

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temporal augmentation allows for improved patient satisfaction with limited risk of
complications. To synthesize the available literature on cosmetic temporal augmenta-
tion, including all available methodologies, patient satisfaction data, and complication
rates, as well as to identify gaps in the available literature to encourage further
research. A literature search was performed using the databases PubMed, Ovid
Medline, Cochrane Library, and Web of Science. Using the key terms “temporal” or
“temple” and “augmentation” or “rejuvenation,” all article formats presenting primary
literature data involving cosmetic temporal augmentation were included. Articles not
presenting patient data or not discussing cosmetic indications were eliminated. A total
of 12 articles were deemed appropriate for analysis. Of the 12 articles included, 6 (50%)
evaluated filler techniques, 3 discussed fat grafting (25%), and 3 reviewed solid implant
Keywords (25%) techniques. Eight (67%) of these were retrospective reviews, with the remaining
► temporal being prospective trials (33%). All studies found high patient satisfaction rates and a
augmentation small number of complications with their respective methodology. Several methods
► temporal are employed for cosmetic temporal augmentation, including various types of
rejuvenation injectable fillers, solid implants, and fat grafting, with all reporting successful satisfac-
► temporal hollowing tion and complication outcomes. Further research is necessary to properly compare
► plastic surgery these modalities. Clinician discretion should guide procedural choice until future well-
► facial plastic surgery controlled studies are able to provide standardized outcomes.

Human aging is marked by a progressive loss of volume
and tissue elasticity in the face.1,2 Fat and muscle compo-
nents are particularly important in the shaping of the
upper face region, and as the aging process occurs, a loss
of soft tissue in the temporal area can result in a hollowed,
gaunt appearance.3,4 This can be perceived as unappealing
due to increased facial concavity and can lead patients to
seek correction of this area and achieve a more youthful or
aesthetically pleasing appearance.3,5 Temporal augmenta-
tion is a versatile procedure used for a variety of purposes,
one of which being aesthetic enhancement of the temporal
anatomy for concavity correction.6 Several approaches
exist, including the use of grafts, implants, fillers, and
flaps. The method employed is dependent upon the goal
of the procedure as well as clinician preference.7–9 Despite
the variety of methods available for aesthetic temporal
augmentation, there is no comprehensive literature
review of these various techniques. The purpose of this
systematic review is to describe the existing surgical
methodology and technique-specific complications and

Issue Theme Applied Anatomy for Facial Copyright © by Thieme Medical DOI https://doi.org/
Plastic Surgery; Guest Editors: Yves Publishers, Inc., 333 Seventh Avenue, 10.1055/s-0039-1694029.
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Temporal Augmentation Othman et al.
to highlight previous study results on aesthetic temporal
augmentation.
Methods
A systematic review of the literature in the English language on
articles describing temporal augmentation was conducted in
November 2018. The search strategy involved using the key
terms “temporal” or “temple” and “augmentation” or “rejuve-
nation” using PubMed, Ovid Medline, Cochrane Library, and
Web of Science. This methodology yielded 3,213 articles.
Inclusion criteria consisted of articles discussing temporal
augmentation performed for aesthetic purposes, as well as
presenting original research involving patient data with a
specific procedural method. Exclusion criteria included any
other primary procedure objectives, such as reconstructive
or pathological disease states, without mention of any data
discussing cosmetic temporal augmentation. Additionally,
review articles and research that did not present original
patient data were eliminated.
After removing duplicates and screening articles at the
abstract level, 36 articles remained. A full-text analysis of the
remaining studies was conducted. Additionally, a search of
their reference sections was conducted to identify any
additional studies meeting criteria. The exclusion processes
are summarized in the PRISMA (Preferred Reporting Items
for Systematic Reviews and Meta-Analyses) flowchart
(►Fig. 1). Once the list of articles was finalized, each study
was categorized into a specific modality, which included
fillers, grafts, and implants. Satisfaction and complication
rates were collected or calculated from the information
provided in each article. Note that the authors had intended
for flaps to be analyzed in the review, but found no existing
literature to meet the inclusion criteria.
Fig. 1 Search strategy and results. Detailed processes of the search strategy, stratification, and results.
Facial Plastic Surgery
Results
In total, 12 articles were selected for the final manuscript
inclusion. ►Table 1 displays the study design and methodol-
ogy for each article analyzed in our review. Procedure
satisfaction results and complications are summarized in
►Tables 2 and 3, respectively.
Fat Grafts
Autologous fat grafting is an approach used to contour the face,
breast, and other body areas for cosmetic and/or reconstructive
purposes.10 Its advantages stem from low immunogenicity,
low cost, malleability, accessibility, and induction of angiogen-
esis to promote tissue survival and long-term outcomes.11,12
When used for temporal augmentation, intimate knowledge of
neurovascular anatomy is necessary to avoid injury and com-
plications.3,5 These complications include poor aesthetic out-
comes, hematoma, seroma, nerve injury, and blindness.8,13,14
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Our review yielded studies evaluating traditional microautol-
ogous fat with a specialized apparatus (the “MAFT-Gun”),
targeted volume restoration, and stromal vascular fraction
(SVF) assisted cell therapy.
Traditional Microautologous Fat Transfer-Gun
Traditional microautologous fat transfer (MAFT) is one well-
known procedure used for fat grafting. However, high variability
in efficiency, efficacy, and complications led to the production of
a specially designed graft placement device.15 The “MAFT-Gun”
was developed to inject specific aliquots of fat and has shown
previous success in other fat grafting procedures.16 This device
allows for more accurate injection volumes to increase efficacy
and patient satisfaction and reduce major complications such as
necrosis and fibrosis.14 Lee et al examined this methodology
applied to aesthetic temporal augmentation and found the
 Temporal Augmentation Othman et al.

Table 1 Study design and characteristics

Study (year) Modality Material/method Design Sample size Level of

evidence
Huang et al (2018) Fat graft Targeted volume restoration Retrospective review 96 3
Li et al (2013) Fat graft SVF-assisted cell therapy Controlled prospective trial 19 1
Lee et al (2017) Fat graft Microautologous fat graft Retrospective review 208 3
transplantation
Moreira-Gonzalez Filler Hydroxyapatite granules Retrospective review 12 3
et al (2003)
Moradi et al (2011) Filler Small gel hyaluronic acid Retrospective review 20 3
Moradi et al (2013) Filler Small gel hyaluronic acid FDA-approved, prospective 20 1
blinded, open-label trial
Lambros (2011) Filler Dilute hyaluronic acid Retrospective review 40 3
Juhász et al (2018) Filler Calcium hydroxyapatite Single-investigator, nonblinded 20 2
prospective study

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Byrd et al (1993) Filler Hydroxyapatite granules Retrospective review 43 3
Lin et al (2010) Implant Expanded Prospective series 16 2
polytetrafluoroethylene
Hirohi et al (2018) Implant Methyl methacrylate Retrospective review 41 3
Gordon and Implant Methyl methacrylate Retrospective review 35 3
Yaremchuk (2011)

Abbreviations: FDA, U.S. Food and Drug Administration; SVF, stromal vascular fraction.

Table 2 Reported patient satisfaction rates

Name Very Unsatisfied/no Neutral/minimal Satisfied/moderate Very satisfied/much

unsatisfied improvement improvement improvement improvement
Moreira-Gonzalez - 3.6% - 96.4% -
et al (2003)
Moradi et al (2011) - 0% 0% 100% -
Moradi et al (2013) - 0% 25% 30% 45%
Lambros (2011) “Most patients and author satisfied”
Juhász et al (2018) - 21% 36.8% 15.8% 31.6%
Byrd et al (1993) Not provided
Lin et al (2010) “Most satisfied”
Hirohi et al (2018) - 0% 6.1% 17.1% 76.8%
Gordon and Not provided
Yaremchuk(2011)
Huang et al (2018) - 8.3% - 25% 66.7%
Li (2013) “All improved”
Lee et al (2017) 0% 2.4% 16.3% 42.8% 38.5%

Note: Hyphen indicates “not discussed.”

patients to be overall satisfied with the results (►Table 2)
without major complications (►Table 3).16
Targeted Fat Volume Restoration
Recently, there has been a surge in interest for targeted volume
restoration. Recent studies have demonstrated an increased
natural appearance along with decreased complications.17,18
Huang et al used harvested fat to inject fat compartments deep
to the superficial temporal fascia followed by a more superfi-
cial, subcutaneous layer injection in the surrounding areas.19
Patients reported high satisfaction rates (►Table 2). Postoper-
atively, 94.8% of patients reported no or mild hollowness on
the Hollowness Severity Rating Scale (HSRS).19,20 Minor com-
plications were reported (►Table 3). Volume restoration was
also measured with a three-dimensional (3D) topographic
scan, which showed a 91.8% increase in augmentation.

Facial Plastic Surgery

Temporal Augmentation Othman et al.

Stromal Vascular Fraction Assisted Cell Therapy

Revision
One variation of pure fat grafting is SVF-assisted cell therapy.

12.2%
6.3%
NOS

14%
Previous literature showed that adipose stem cells increased

1
graft survival time through the promotion of vasculogenesis.21

-
Li et al demonstrated this method by fat harvesting with
Facial nerve

subsequent centrifugation into SVF.22 This stromal rich cen-

damage

trifugate was compared against a control group using tradi-

6.3%
2.4%
tional fat harvesting injected into various facial sites including

0
-

-
-
the temporal region. Volumes were measured using computed
tomography (CT) scans. The mean graft survival was 64.8 for
pain
Jaw

5%
5%

the SVF group and 46.4% for the control group at 6 months
-

-
-
-
-

-
postinjection. There were no reported complications
Tenderness/

(►Table 3), and all patients had cosmetic improvement, but

numbness

temporal outcomes were not specifically reported (►Table 2).

100%

2.4%
70%

Fillers
-

-
-

-
The advent of fillers allows for contouring and volumization of
asymmetrical or aged areas for a more aesthetic perception.23

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Infection

As a result, the role of fillers has grown in the correction and

preservation of temporal fossa volume. There are several
0%

0%
0%

0
-

different types of fillers with a variety of material compositions.

Most notably in our review, the use of hyaluronic acid (HA) and
Bruising

calcium hydroxyapatite fillers was described for aesthetic

30%
70%

temporal augmentation. Fillers carry a similar risk profile in

-

-
-
-
-

terms of complications and injury to neurovascular structures,

as listed in the Fat Grafts section.24,25 Specifically, the middle
Skin irregularities/

temporal vein (MTV) is one vessel responsible for filler-related

complications including, but not limited to, hematoma, embo-
lism, and obstruction.26
4.9%

5.2%
rash

10%
55%

Hyaluronic Acid
0%

0%
-

Hyaluronic acid is an intrinsic molecule that allows skin to

retain turgor and pliability, largely due to its moisturizing
Headache

and water-retentive properties.27 In cosmetics, the innate

7.3%

properties as well as clinical utility of HA-containing fillers

75%

vary because of differences in manufacturing. Moradi et al

-

-
-

-
-
-

evaluated the small gel particle HA (SGP-HA) filler, commer-

Swelling /

cially known as Restylane (Galderma).28 SGP-HA functions

seroma

by a particle-induced cohesive gel structure that provides the

100%

2.4%

3.1%
40%

30%
50%

0%

foundation for lift and support, as well possesses predictable

-

water absorption and swelling properties.27,28 All patients in

Redness

this study were injected in the subcutaneous plane superfi-

None reported

cial or just deep to the superficial temporal fascia through

40%

30%
65%

anterograde, retrograde, and depot injection methods. All

-

-
-
-
-

patients reported satisfaction with their appearance, some

None

None
Pain

55%
80%

with mild tenderness and bruising (►Tables 2 and 3).

Table 3 Reported complications rates

-
-
-
-

A follow-up prospective study by the same senior author

Note: Hyphen indicates “not discussed.”

evaluated SGP-HA filler (Restylane) in the correction of tempo-

Gordon and Yaremchuk (2011)
Moreira-Gonzalez et al (2003)

ral fossa volume loss.20 Creating a measure termed “Hollowness

Severity Rating Scale” (subsequently used by Huang, as
discussed in the Fat Grafts section) to grade the degree of
Moradi et al (2013)

hollowness in the temporal areas, the study showed significant

Huang et al (2018)
Juhász et al (2018)

Hirohi et al (2018)
Moradi et al 2011

Byrd et al (1993)

improvement comparing pre- and postinjection scores. Most

Lambros (2011)

Lee et al (2017)
Li et al (2013)

patients were satisfied, although the degree of satisfaction

Lin (2010)

dropped from the 6- to 12-month mark (►Table 2). No major

adverse effects were reported (►Table 3).20
Name

Lambros described an HA injection using a modified

dilution formula consisting of 2:1 saline:Restylane or Perlane

Facial Plastic Surgery


HA.29 Juvéderm was not used, as it was it cited to have a
higher degree of injection difficulty due to its viscosity. The
hypothesis behind this method is a greater volume of solu-
tion allowing for greater distribution of filler for a more
uniform, smooth look, extending from the lateral orbit/
eyebrow throughout the temporal area. The author reports
a high degree of satisfaction (►Table 2) with small, correct-
able adverse effects (►Table 3).
Calcium Hydroxyapatite
Calcium hydroxyapatite is a mineral found endogenously
within human teeth and bone. It is a well-studied material,
and its efficacy as a filler stems from its versatility and ability to
act as scaffolding material and stimulate growth of surround-
ing tissue, more specifically collagenous dermal material.30
Moreira-Gonzalez et al studied porous hydroxyapatite gran-
ules as filler material. Of note, the study combined aesthetic,
congenital, and posttraumatic indications for procedures, and
these indications were not distinguishable numerically.31
Additionally, facial locations were varied for placement of
the material, but 3% of the study cohort had filler applied to
the temporal region. Of the patients, 96.4% (n ¼ 379/393)
reported satisfaction, but temporal satisfaction was not speci-
fied (►Table 2). Complications were specified anatomically,
although none occurred in the temporal region (►Table 3).
Byrd et al presented their experience with porous hy-
droxyapatite granules as a filler in combination with patient
blood and fibrillar collagen to form an injectable paste for
craniofacial defects through fibrous incorporation.32 Similar
to the study by Moreira-Gonzalez et al, this study examined
both aesthetic and reconstructive indications without com-
paring the two. Multiple craniomaxillofacial locations were
treated, with 8% of cases occurring in the temporal region.
Patient satisfaction was not discussed, and no adverse out-
comes were reported (►Tables 2 and 3).
Juhász et al reported the off-label use of calcium hydroxy-
apatite with integral lidocaine (Radiesse; Merz North America,
Inc.) for temporal fossa defects.33 They injected into the deep
facial plane using several technique variations including linear,
bolus, threading, and fanning. Using the Merz-validated Tem-
ple Scale Assessment, a previously validated scale that assesses
temporal fullness, results showed mixed patient satisfaction,
although the largest group remained satisfied (►Table 2).
Expected minor complications were reported, such as tender-
ness and swelling, but no major complications were observed
(►Table 3).
Implants
Cosmetic implants are generally a prosthetic or allogenic
material used to augment certain anatomical areas for
aesthetic contouring.34,35 The use of implants for temporal
augmentation was investigated because previous traditional
modalities, such as injectable fillers and fat grafts, had less
predictable survival time, limited availability, and decreased
pliability.34,35 However, implants present their own chal-
lenges to clinicians, including difficulty in identifying good
surgical candidates, improper implant size selection, and
inappropriate implant location placement, as well as migra-
Temporal Augmentation Othman et al.
tion and extrusion.35,36 Traditional complications are also
possible, including seroma, hematoma, and infection.36 In
our review, we identified studies using methyl methacrylate
(MMA) and polytetrafluoroethylene (PTFE) implants for
aesthetic temporal augmentation.
Methyl Methacrylate
Methyl methacrylate is a resin used for craniofacial and
temporal augmentation.37,38 This material successfully
addresses full-thickness defects of the skull while being mal-
leable, biocompatible, and nonabsorbable. In addition, it is low
in cost and produces a predictable result.39,40 Unlike other
implants, MMA is placed in a submuscular pocket rather than a
supramuscular pocket, which significantly reduces damage to
the frontal branch of facial nerve.39 Gordon and Yaremchuk
briefly discussed their experiences and results with MMA for
aesthetic temporal augmentation.39 Satisfaction and appear-
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ance scores were not explicitly discussed (►Table 2). However,
they mentioned that 14% of patients required revision surgery,
citing contour dissatisfaction, overcorrection, and coronoid
process impingement as the etiology. No other complications
were reported (►Table 3).
Hirohi et al examined integrated forehead temporal aug-
mentation compared with single forehead augmentation
with MMA.40 Using a four-point pre- and postoperative
rating scale, two blinded, unaffiliated plastic surgeons rated
temporal hollowing. Citing the growing popularity of 3D
printed technology, customized MMA implants were used.
Procedure technique began with a head CT scan for each
patient that was used to produce a 3D skull model to allow
for MMA contouring and design followed by surgical implan-
tation. Most results (76.8%) involving temporal augmenta-
tion were rated as “excellent” by the two reviewers, the
maximum possible score (►Table 2). Despite good overall
results, there are potential complications including the need
for revision procedures (►Table 3).
Polytetrafluoroethylene
Expanded-PTFE (e-PTFE) is a synthetic fluoropolymer with
proven biocompatibility. It has been used for a wide variety
of clinical applications including craniofacial reconstruc-
tion.41,42 The advantages of e-PTFE include reduced incidence
of capsular formation and inflammatory response.43 Like MMA,
it also has good biocompatibility.44 Lin et al reported their
experience using e-PTFE, with standard 60  40  2 mm
sheets.45 The implant can be placed with the assistance of an
endoscope providing smaller incisions with fewer complica-
tions. One patient had paralysis of the temporal branch of the
facial nerve that recovered, and most (96.2%) were satisfied
(►Table 2).
Discussion
In cosmetic surgery, temporal augmentation has the flexibility
of employing several modalities designed to accomplish simi-
lar goals such as volume restoration and aesthetic facial
contouring.5,6,9 This approach is traditionally left to the clini-
cian’s discretion. Understanding the various methods and
Facial Plastic Surgery
Temporal Augmentation Othman et al.
complications can allow providers to opt for the best individ-
ualized option for their patients.
One goal of a cosmetic procedure is to achieve a high level of
patient satisfaction. Understanding which techniques are most
effective in terms of patient satisfaction is difficult to accom-
plish within a systematic review. The articles we examined
were largely retrospective reviews, whereas the prospective
studies were not randomized trials. Qualifying patient satis-
faction can be accomplished by standardizing age, gender,
and degree of temporal volume deficits. Some studies used a
previously validated and standardized scale (HSRS), with
blinded reviewers and follow-up times in an attempt to
standardize results. Unfortunately, most of the other studies
relied on self-reported patient satisfaction scores. The majority
of patients were satisfied with their procedures, with varying
categorization (►Table 2). The different measurement scales
were not standardized, which can skew results. Future
research should incorporate a validated patient questionnaire
on satisfaction in order to better qualify how patients self-
perceive various procedural results.
The studies included in this review reported several com-
plications, but almost all were minor, known, or resolved
complications on follow-up (►Table 3). Some have reported
alopecia in the temporal area secondary to a disruption of hair
follicles.46 Another cosmetic concern is scaring and disruption
of natural skin textures.47 Nonablative and ablative fractional
resurfacing and radiofrequency skin tightening have helped
alleviate some concerns with a host of applications including
scar and acne removal. By creating microdamage within the
dermal layer, neocollagenesis and contraction are stimulated,
helping tighten skin and eliminate defunct tissue, making
these complications less of a concern in terms of their long-
term damage.47–49
Previous research, much of which is purely anatomical, has
found more potential adverse effects of temporal augmenta-
tion given the complex anatomical nature of the temporal area.
The superficial temporal fascia is thin in patients with tempo-
ral hollowing and confers a great risk to all the neurovascular
structures it encompasses.37,50,51 Several studies in our review
reported transient paresthesias secondary to facial nerve
damage, but the risk of permanent damage remains unknown.
When considering the vasculature, the frontal branch of the
superficial temporal artery and the sentinel vein course through
the temporal regionwith several branches, including the MTV.52
There have been reports of embolisms erroneously being
introduced into the vasculature during the injection of materials
for temporal augmentation, which can lead to pulmonary
embolism, blindness, and hemiplegia.53,54 Hematoma and ob-
struction of vessels are also possible.25 The zone of caution, an
area believed to be associated with the highest complication
rate, is the anterior half of the lower temporal compartment that
contains these crucial neurovascular structures.5,25
Several materials and surgical methods were not covered in
our review due to the lack of cosmetic indications. Two of the
more commonly used implants for temporal augmentation
include PTFE (i.e., Gore-Tex) and porous polyethylene (i.e.,
MEDPOR) implants.37,39,55 PTFE implants are a favorable
alternative to other alloplastic implant materials in regard to
Facial Plastic Surgery
biocompatibility, minimal foreign body reaction, low extru-
sion rate, and lack of excessive capsule formation.37,55 Porous
polyethylene implants are mainly used for bone due to its
stiffness.37 In addition, these implants have micropores, which
allow surrounding tissue to grow through lattice networks as
opposed to encapsulation. The vascularized soft tissue
network throughout the implant reduces the likelihood of
infection and movement over time.37,39,55 In contrast, materi-
als with larger pore sizes can experience material breakdown
and foreign body reactions when used improperly, such as
woven Teflon and organic fibers (i.e., Proplast; Vitek Inc.).56,57
The Eppley temporal shell implant, produced by Implantech, is
another option used by the senior author (J. B.) with good
results. Composed of solid silicone, it is believed to be advan-
tageous due to its soft composition when compared against
other silicone implants. This allows for greater contour adap-
tation to the natural shape of the skull.58 No studies have
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examined this material closely, making its tangible efficacy
and complications largely unknown. The ongoing controversy
with these materials is their ideal location within the temporal
area, either submuscular or supramuscular.39 The literature
has not defined the more effective method.
Mersilene mesh is a less described implant used in
temporal augmentation. It is often used for craniofacial
reconstruction in the skull, sinus, cheek, nasolabial sulcus,
nasal septum, and chin.59 Mersilene mesh is constructed
from polyester, producing a smooth and pliable material
with elastic properties that allow it to adapt to mechanical
stresses. One study used the mesh for various reconstructive
procedures with reported success.59 Further research should
examine its utility.
Poly-L-lactic acid (PLLA, Sculputra [Dermik Laboratories])
is a widely used polysynthetic, biostimulatory injectable for
facial and temporal volumization and rejuvenation.9 The
advantage of PLLA is believed to stem from its collagen
stimulating mechanism of action. This allows for longer lasting
and natural changes.60 Although the literature has shown its
success in volumization, a study is necessary to specifically
evaluate the application of PLLA in temporal augmentation.61
Ellansé (Sinclair Pharma Ltd.) is a collagen biostimulator
composed of polycaprolactone filler based material used
over several regions of the body including the temporal
region.62 This material has successful outcomes in nasolabial
fold injections.63 The injection should be placed between the
superficial temporal fascia and the superficial layer of the
deep temporal fascia using a 22 or 25G blunt cannula,
fanning from the posterior limit to the orbital rim and
zygomatic arch. Deep, preperiosteal injections can also be
employed using a low-pressure bolus injection technique.
Although research describes its use in the temporal region,
there are very little existing data for this purpose.62 This
material is currently not approved by the U.S. Food and Drug
Administration. However, given its success, it warrants an
examination for various facial cosmetic purposes.
Fat grafts are well described in this review and in many
other cosmetic procedures. Pessa et al conducted an ana-
tomical study warning of the complications mentioned in the
Fat Grafts section.3 Further complications can include

calcification and tissue necrosis.64 The long-standing issue
with fat grafting, however, is the lower rate of survival owing
to the lack of vascularization.65
Bone grafting is another alternative used for temporal
augmentation. Temporal hollowing, for example, is a rela-
tively known common complication of craniotomies. Several
studies cite autologous bone graft, often calvarial, as an
effective method following craniotomy to combat loss of
volume in the temporal area.66 Given the invasive nature of
these procedures, they are unlikely to be used in aesthetic
temporal augmentation when compared with time-saving
and cost-intensive options mentioned in this review.
We initially intended to include flap-based strategies for
cosmetic temporal augmentation. Flaps are vascularized
tissue consisting of skin, fat, muscle, bone, or a combination
of these materials. No flap research met the inclusion criteria
in this review, as this has traditionally been a reconstructive
procedure for trauma, congenital defects, or tissue-wasting
pathology.67 Wolff et al described good success using antero-
lateral thigh adipofascial flaps for temporal reconstruction.68
The main advantage of flaps is the low rate of autoimmune
reaction. In cases of reconstruction, flaps also provide the
advantage of sufficient volume construction in areas of
large defects.68,69 The practically of flaps, however, may
explain the reason for its seemingly low use in aesthetic
temporal augmentation. Flap vascular dissection can also be
difficult from a technical skill standpoint and can predispose
tension-related ischemia and infection.70 Variations in
anatomy can also present inconsistent difficulties.68,70 Fur-
thermore, the temporal anatomy consists of a smaller area
not always necessitating large flap coverage. No studies have
examined these methods for cosmetic temporal augmenta-
tion. Research is needed to qualify flap utility in aesthetic
temporal augmentation.
A further limitation of this review was the lack of a formal
analysis comparing all of the modalities. In some articles, the
technicality of the procedure was unclear, making it difficult to
analyze patterns. As mentioned previously, satisfaction rates
were not standardized and not always quantified by the patient
or the clinician themselves. Finally, reported complications
were unstandardized and variable. Some studies presented
every complication, whereas others omitted minor complica-
tions or failed to present them entirely.
Currently, patient-specific needs should guide modality
selection. This includes the patient’s desire for operative versus
nonoperative options, preference for treatment longevity, ease
of procedure, and cost. The ideal technique will vary depend-
ing on patient-specific context. The surgeon should consider all
possible modalities on a case-by-case basis when creating a
proper approach for each patient.
Conclusion
Temporal augmentation is a cosmetic procedure with nu-
merous available approaches and options. Each approach is
associated with various advantages and disadvantages in
regard to satisfaction rates, practicality, and complications.
A summary of known modalities for cosmetic temporal
Temporal Augmentation Othman et al.
augmentation has not been well described previously. We
were able to examine the existing methods used for aesthetic
temporal augmentation, which should encourage further
research on this topic.
Conflicts of Interest
Dr. Bloom reports personal fees from Allergan, Galderma,
Merz, ThermiAesthetics, InMode, Prollenium, Revance
Therapeutics, Endo Pharmaceuticals, and Evolus outside
the submitted work. The other authors have no conflict of
interest to disclose.
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