Temple Acne Scars - Is Juvederm not suitable for a microdroplet technique? (Photos)

Question

Seen multiple specialists for temple acne scars that haven’t responded to laser treatments. Two now recommend subcision with a deep permanent filler (Sculptra), along with a superficial filler for final smoothing (Bellafill vs. micro-droplet silicone). I’m terrified of permanent fillers. Why wouldn’t we start with a reversible HA filler (like Juvederm) using a micro-droplet technique to achieve a similar surface result? I had Juvederm placed in my lips more than 3.5 years ago and haven’t seen ANY loss of volume. I understand that may be due to a collagen response, but even so, wouldn’t that suggest it could be a good option for the temples in this case if I clearly produce a decent amount of collagen from a minimal amount of HA filler? If HA lasts well for me and can stimulate some collagen, isn’t a long-lasting temporary approach better? Or is it not suitable to use a micro-droplet technique with Juvederm? Is there any risk in using Juvederm in the temples and simply planning for touch-ups every 1–2 years long term?

Anna Chacon, MD, FAAD · Answer

This is a really smart question.

In theory, HA fillers like Juvederm can:

Provide temporary volume
Stimulate some collagen

However, the reason specialists are recommending otherwise is:

The temple is a high-risk vascular area
Microdroplet technique with HA in scars can be:
Less predictable
More prone to irregularity
HA spreads differently than permanent fillers

Also:

Your lips holding filler for years doesn’t always translate to other areas
Temples behave very differently anatomically

You’re not wrong—but in practice, HA is often not ideal for this specific technique and location.

A cautious middle ground:

Start with reversible options (HA) but in appropriate planes, not microdroplet surface work
Avoid jumping straight to permanent fillers unless you’re absolutely sure

Hung William Song, MD · Answer

Bellafill is FDA cleared for acne scars. That's why it is promoted but I find that hyperdilute HA filler work better especially if combined with PRP/PRF. I see the best results with subcision followed by hyperdilute HA filler with PRP.

Nelson Lee Novick, MD · Answer

Unfortunately, I'm not surprised by the lack of success of the laser treatments. I have been cautioning my regular followers for years to exercise a great deal of "buyer beware" caution when being hawked these expensive, "bells and whistles" gizmo treatments, since the hard science to back up their use lags well behind the marketing hype and social media buzz to hawk them. Sorry.
I have been performing subcisions for over thirty years. For extensive scars on the temples, I would consider a Field Subcision first before considering addressing individual scars. The Field Subcision typically reduces the prominences of many of the overlying scars, such that the need for subsequently performing many individual subcisions is typically significantly reduced. This can be done with or without the use of an HA filler (best to use a low viscosity, malleable, cohesive one). I gave up injecting Sculptra more than a decade because, unlike with HA fillers, there is no enzyme to dissolve the product should any adverse reactions arise. 
Finally, following the Field Subcision, should there be any residual, particularly bothersome acne scars remaining, these can be addressed with individual subcisions +/- the use of microdroplets of HA filler. 
You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist acne scar specialist experienced in performing subcisions. Hope this helps and best of luck.

Temple Acne Scars - Is Juvederm not suitable for a microdroplet technique? (Photos)

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