Are fillers for temples safe? Worried about blindness. Does “aspiration” guarantee you’re not hitting vessel? (photo)

Question

I have significant volume loss in the temple region on both sides of my face, as seen in the picture. I’ve researched and it seems fillers are the only possible treatment. Is that correct? I worry about the blindness possibility that’s linked to fillers, though. Is there a way to know beforehand that the risk is eliminated? Does the “aspiration” test guarantee you’re not hitting a vessel?

Hung William Song, MD · Answer

Vision loss with filler injections is something that has been reported. It is very rare but obviously catastrophic if it happens, especially for an elective procedure. Your risk is exponentially reduced if the injector knows what they are doing. The temples are actually less risky than injecting frown lines between the eyes. When using a needle to inject, the filler should be injected on the bone where there are no blood vessels. Injections can be done more superficially but a blunt cannula should be used. The bigger the cannula, the less risk of penetrating a blood vessel. The injection should be performed very slowly. Aspirating before injecting is helpful, but not a very reliable way to avoid injecting into a vessel. Using a long lasting product like Bellafill or using your own fat will reduce the risk because you will not need to keep repeating the treatment. If you go to a doctor who is properly trained and very experienced, you need not fear getting fillers in the temples any more than you would fear getting on an airplane.

Michael A. Zadeh, MD, FACS · Answer

Thank you for your question and pictures. Fillers are a great option for restoring volume in hollow temples. I often combine Fillers with Sculptra to provide a longer lasting result. In the right expert hands, with extensive knowledge of anatomy and use of proper technique the injections can be performed safely. Aspiration is not a guarantee that you're not in a vessel. Make sure you see an experienced physician for an in-person consultation and examination. Best wishes.

Nissan Pilest, MD · Answer

Hollow temples are the most commonly overlooked area. As we age subcutaneous tissue is lost leaving a “skeletal-like” appearance. Needle technique is one of the most important factors when it comes to Dermal Filler. What makes a physician an “Expert Injector” is the understanding of the facial anatomy to lower any risks.
You must understand there is always risk associated when injecting in the temples. Drawing back on the syringe may lower these risks, but false-negative aspiration can happen. 
  
My suggestion is to look for a Physician that has years of experience in Temple Fillers and knows the proper protocol if a vessel is hit.

Benjamin Van Raalte, MD · Answer

Filler to the temples is relatively safe procecedure. By infiltrating with lidocaine with epinephrine and use of a blunt cannula in this region, I believe it is even safer. Fillers and fat grafting are options. Renuva might also be a good option, as it is a human derived filler with potential for longer lasting by ingrowth of your own fat cells. I have used Juvederm and Vollure, and done fat grafting. Fat grafting is the most economical for the amount sometimes needed. A practitioner should have hyaluronidase on hand if injecting fillers for emergencies.

Richard Ort, MD · Answer

In experienced hands, filler injection is a very safe procedure. Vascular compromise leading to blindness has been rarely reported after filler injections. Fortunately, this is a very rare side effect and very unlikely with good technique. (Not something that most injectors have encountered). Aspiration can be helpful but it is not a guarantee that you are not in a vessel. The most important decision is to choose your injector wisely. Risk cannot be completely eliminated but an experienced injector using good technique will help minimize any risks.Regards,Dr. Ort

Tyler Rogers, MD · Answer

Very good question.  Fillers in the temples are very safe and in fact safer than some other areas of the face.  There is no such thing as completely eliminating risk.  But I would not hesitate to get temple filler from an experienced and skilled injector.
The temples can require a lot of volume.  I prefer Sculptra with a cannula technique for safety, better value, and longer lasting results.  Bellafill and fat are also good longer lasting options.  There are many more good options to discuss with your physician.

Bennett Yang, MD · Answer

Hello and thank you for the question. There are no guarantees in plastic surgery. The only risk free option, is NOT to have plastic surgery. Fillers work well in the temples. Fat works better. Having a liposuction procedure, where the fat is collected, purified, and then reinjected is one of the most common procedures done today. Most of it is used in butt and breast cases, but fat to the face is extremely effective, safe, and has longevity. Face fat injections will typically last many years if not permenent. I typically will use 5-6 cc of fat per temple area. If you compare that the fillers, the cost of the fillers would run around 7000-8000. Fillers will not last more than a year in most cases. For examples, please see my instagram feed: @bennettyangmdBest to you.

Daniel Lafond, MD · Answer

No one can give you a 100% garanty but blindness is extremely rare. Doctor skill and experience are the most important tools for you. Hyaluronic acid and Poly-L-lactic acid and my best choice for this area.
Best regards from Montreal, Canada!

Jo Herzog, MD · Answer

There is never any guarantee but aspiration helps. I think that the best filler for this area is Sculptra. This is a thin product that is easy to aspirate and will give you significant volume and last a long time. I would see a dermatologist that has a lot of experience with this product as that is the key to success.

Hassan Galadari, MD · Answer

when injected in the right plane and using the right filler and technique, then placement of fillers in the temples will do wonders aesthetically. Granted they are considered to be a relative danger area, but being adept in anatomy deters possibility of potential complications. You would need to see a highly skilled practitioner to have this procedure performed. As for aspiration, according to a study published in Dermatologic Surgery journal, a negative aspiration does not guarantee that the product is not in the vessel.

Are fillers for temples safe? Worried about blindness. Does “aspiration” guarantee you’re not hitting vessel? (photo)

Answers (11)

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