Will increasing volume in the temples reduce the lateral protrusion of the zygoma arch? (Photos)

Question

24F, ethnicity - indian. I really dislike how wide my zygoma arch is. I am not interested in zygoma arch reduction as its too invasive. I have heard there are ways of increasing volume in the temples to give a smoother transition. In the photo attached, the left is original and right is my edit. I made this edit using a liquify tool. My questions are 1) how achievable is the result realistically 2) what is the best way to achieve this kind of volume in the temples. Fillers? Fat transfer? 3) how sustainable are the results of the methods used?

Michael P. Morrissette, DDS, FACS · Answer

There are both temporary and permanent solutions for temporal hollowing. Fillers and fat can be injected into this region to increase the lateral projection. Both fat and fillers will require yearly replacement. In addition, this region can take anywhere from 2-4 syringes of filler to obtain adequate correction. A permanent solution can be achieved with silicone temporal implants. They are placed through a small incision in the hairline and placed into a pocket. They look and feel natural. This is a one-time treatment. There are both stock and custom implant options.

Nelson Lee Novick, MD · Answer

Over the past decade, HA Filler Temple Augmentation for addressing temple hollows has become a routine procedure in the hands of experienced, board certified cosmetic dermatologist filler injector experts. Results may last up to 1.5 years, which is fine, since subsequent treatments can then be better matched to the inevitable changes that occur with aging in the surrounding tissues. What's more, HA fillers can typically be easily dissolved should the need ever arise. 
Surgery, on the hand, carries not only expense and postoperative downtime, but the risk of scarring and complications, which cannot be easily reversed. 
And while on the surface of things, it would seem that fat transfer injections would yield permanent results, the reality is that much of the fat, separated from the blood supply of the donor region, does not typically survive, and, that which does survive is permanent, so that if there are any complications or adverse reactions (either immediately following treatment or years later), these can be very difficult to reverse. (For these reasons I personally gave up performing fat transfer many years ago.)
In cases where patients are unsure, I offer the option of a real world "filler " test, in which just dilated saline or anesthetic is injected, which gives an immediate result that lasts about five or ten minutes (before being reabsorbed), and provides enough time for the person to get a real world idea of the potential result when the actual HA Filler is used.  Hope this helps and best of luck.

Carl Truesdale, MD · Answer

Temple filler is a useful tool for softening the visual prominence of the zygomatic arch, but the underlying anatomy determines how much improvement you can expect.
If your zygoma protrusion is mostly soft tissue (lateral cheek fullness, masseter mass) the appearance is influenced strongly by adjacent areas. Filling the temples adds upper face volume that visually balances the lower face. This works well in patients whose temples are hollow and zygoma is moderately prominent.
If your zygoma protrusion is bony (true wide bizygomatic distance), temple filler softens the contrast but doesn't reduce the actual arch. The zygoma is still where it is, you've just added volume next to it. Some patients are happy with the visual rebalancing, others find it doesn't go far enough.
A few practical considerations:
Conservative dosing matters. Overfilled temples create a 'puffy' upper face that doesn't read as natural. 1 to 2cc per side is usually enough for most patients.
Product choice matters. Voluma or RHA 4 are good for temples because they integrate well in the deep temporal fat pad. Avoid superficial placement near the surface vessels.
Permanent solutions: zygoma reduction osteotomy is a real surgical option for patients with significant bony prominence who don't get satisfaction from filler. This is more common in Asian aesthetic surgery and is performed through the mouth. Not all surgeons do this routinely. You'd want one experienced specifically in zygoma reduction.
Filler is reversible, so it's a reasonable starting point if you want to test the approach before considering surgical options.

Will increasing volume in the temples reduce the lateral protrusion of the zygoma arch? (Photos)

Answers (3)

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