Sunken temples
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Sunken temples are a visible reduction of tissue volume in the lateral part of the upper face, between the forehead, orbit, zygomatic bone, and scalp. The hollowing may be an anatomical feature present since youth or a consequence of aging, fat loss, temporalis muscle atrophy, bone remodeling, or a systemic disease. As the deficit deepens, the temples lose their gently convex contour, the orbital rims and zygomatic bones become more prominent, and the face may appear thinner, tired, or older. Correction requires an assessment of the entire face, as not every hollow is an abnormality and not every patient requires direct temple filling. The temporal region has a complex vascular anatomy, which is why injection procedures should be performed by a physician experienced in facial anatomy and the management of vascular complications.
Sunken temples - where are the temples located
The temple is a lateral region of the head located behind the lateral orbital rim and above the zygomatic arch. Its superior border is defined by the temporal line, the anterior by the lateral edge of the forehead and orbit, the inferior by the zygomatic arch, and the posterior by the preauricular region. The visible depression primarily corresponds to the temporal fossa, which is the area where the temporalis muscle is located beneath the superficial tissues.
From superficial to deep, this region includes:
- skin and a thin layer of subcutaneous tissue,
- superficial temporal fascia, which is a continuation of the facial musculoaponeurotic system,
- superficial temporal fat compartment,
- deep temporal fascia, which splits into two layers in its lower part,
- deep temporal fat compartment,
- temporalis muscle,
- periosteum and bones forming the temporal fossa.
Structures of high clinical importance pass through this relatively small area: the superficial temporal artery and vein, deep temporal arteries, middle temporal vein, vessels communicating with the ophthalmic system, and the temporal branch of the facial nerve. The course of the vessels varies between individuals, and some of them are located in different tissue planes. For this reason, describing the temple as a single "safe layer" would be an oversimplification.
In a well-proportioned face, the transition between the forehead, temple, and cheek is smooth. A slight concavity can be natural, particularly in slim individuals and men. An aesthetic concern usually arises when the hollow becomes sharply demarcated, asymmetrical, or exposes the bony contour of the lateral orbital wall.
Sunken temples - why do they sink
Temporal hollowing is most often the result of overlapping changes occurring across several anatomical layers. Facial aging does not consist solely of collagen loss in the skin. It also includes skeletal remodeling, fat atrophy or redistribution, muscular changes, laxity of supporting structures, and reduced skin elasticity.
The most important causes include:
- Anatomical and genetic factors. A narrow upper face, prominent zygomatic arches, thin subcutaneous tissue, or a naturally deep temporal fossa may already be visible in young individuals.
- Tissue aging. With age, the volume of superficial and deep temporal fat compartments decreases. At the same time, changes occur in the temporalis muscle, fascia, and the bones of the lateral skull.
- Significant or rapid weight loss. The loss of facial fat after intensive dieting, a wasting disease, or appetite-suppressing pharmacotherapy can make the temples particularly prominent in previously slender individuals.
- Lipoatrophy. Localized or generalized loss of adipose tissue may accompany, among others, certain autoimmune diseases, infections, metabolic disorders, and specific pharmacological therapies.
- Temporalis muscle atrophy. It may occur in the course of malnutrition, sarcopenia, neuromuscular diseases, innervation disorders, or reduced masticatory function.
- Surgeries and trauma. Unilateral hollowing can be a consequence of neurosurgical operations with a temporal approach, damage to the muscle, fascia, or nerves, scarring, or injury.
- Bite disorders and masticatory dysfunction. Long-term unilateral chewing limitation may promote muscle asymmetry, although it is not a common cause of isolated, significant temporal atrophy.
Gradual, bilateral deepening of the temples is usually physiological. However, rapidly developing asymmetry, pain, muscle weakness, chewing difficulties, unintentional weight loss, or other systemic symptoms require medical diagnosis. An aesthetic procedure should not replace identifying the cause of the deficit.
Sunken temples - why they age the entire face
The temples form an anatomical connection between the forehead, the lateral orbital rim, the eyebrow, and the cheek. Their volume therefore affects not only the local contour, but also the perception of the proportions of the entire face. In a youthful face, the line from the forehead through the temple to the zygomatic bone is usually gentle and continuous. Volume loss replaces this smooth curve with a distinct hollow.
Sunken temples can:
- expose the lateral and superior orbital rim,
- increase the contrast between the temple and the zygomatic arch,
- make the cheeks appear more prominent, even without an actual change in their volume,
- visually narrow the upper third of the face,
- disrupt the smooth transition between the forehead and the cheek,
- accentuate laxity of the lateral eyebrow and periorbital area,
- give the face a skeletal, tired, or emaciated appearance.
The influence of the temples on perceived age results from the overall interplay of light and shadow. A deep hollow creates a shadow next to the bright, convex zygomatic arch and forehead. This increased contrast emphasizes the bony structures of the face and reduces the impression of soft tissue continuity.
However, this does not mean that every concavity requires elimination. In men, moderate temporal hollowing can contribute to a desirable, more angular contour. On the other hand, overfilling can widen the upper third of the face, alter gender-defining features, or create an unnatural bulge. The goal of proper correction is to restore a smooth contour and balanced proportions, rather than completely flatten the temple anatomy.
Sunken temples - how to fill temples
The basis of treatment is a medical consultation including a medical history, assessment of symmetry, temporalis muscle mobility, skin quality, degree of volume loss, and proportions of the entire face. In the case of atypical atrophy, general, dental, neurological, or imaging diagnostics may be necessary. Standardized photography, dynamic assessment, and in selected cases high-frequency ultrasound help plan the appropriate plane of treatment.
Methods available at Ambasada Urody Clinic & Spa that may be used to correct sunken temples include:
- Hyaluronic acid modeling. Cross-linked hyaluronic acid directly restores volume and allows for a precise smoothing of the transition between the forehead, temple, and cheek. The effect is visible quickly, but is temporary. An important advantage is the possibility of enzymatic dissolution of the product with hyaluronidase, although this does not eliminate the risk of severe vascular complications.
- Volumetric face lift. This is the planning of volume restoration across the entire face, rather than the name of a single product. In addition to the temples, the doctor evaluates the cheeks, zygomatic area, forehead, and lateral orbital area to avoid isolated, unharmonious filling.
- Hybrid and biostimulatory fillers, including Radiesse, Crystalis, and products combining hyaluronic acid with a biostimulator. They can provide a supportive effect and stimulate collagen production. In the clinic's offer, temporal hollows are also an indication for some of the products. However, their use depends on the properties of the specific product, approved indications, tissue thickness, and the chosen plane of administration.
- Stimulators with a volumetric effect, including Lenisna. The combination of poly-D,L-lactic acid and hyaluronic acid can gradually improve tissue volume and structure through neocollagenesis. The effect builds up more slowly than with a classic filler, so this method is not intended for very precise, immediate correction of every type of deficit.
- Autologous fillers, including CGF Harmony. The preparation obtained from the patient's blood combines a regenerative fraction with an autologous albumin gel. It can provide subtle support and improvement of tissue quality, but its ability to compensate for a deep deficit is lower and less documented than in the case of classic volumetric materials.
Treatments that improve skin quality and tightness can complement the therapy, but laser, microneedle radiofrequency, ultrasound, or mesotherapy do not replace lost volume. Moreover, aggressive fat-reducing procedures may exacerbate hollowing in a lean person.
The temple is a high-risk area for injections. Possible adverse effects include swelling, hematoma, pain, asymmetry, irregularities, visibility of the product, infection, inflammatory nodules, and nerve compression. The most dangerous complication is intravascular injection or vascular occlusion, which can lead to skin necrosis, visual disturbances, vision loss, or a neurological event. The risk applies to both fillers and autologous fat. No technique reduces it to zero.
The choice of product, volume, cannula or needle, and depth of administration should be decided by a doctor after an examination. The procedure is not performed, among other things, in the presence of an active skin infection, and coagulation disorders, autoimmune diseases, pregnancy, breastfeeding, and previous implants or fillers in this area require special evaluation. After the procedure, sudden severe pain, blanching or blueness of the skin, visual disturbances, drooping of the eyelid, severe headache, or neurological symptoms require immediate medical attention.
