Temple filler is the injection of a filler into sunken or hollow temples to restore volume and balance the face. This article is written for general readers. It explains what the injection layer, injection points and injection techniques (such as the gunshot technique) are, how a filler for the temple area is chosen, and why these choices affect results and risk. It checks them against the anatomical research, small clinical studies and FDA information that could be opened and read, and includes the warning signs that need immediate medical attention. This is general information, not a diagnosis.
Key Takeaways
- Sunken temples are associated with age-related volume loss, making the bone structure more visible. Fillers are one option for restoring volume, but a doctor should assess the degree of temple sunkenness first.
- The temple has many layers, with arteries, veins and nerves close together. The anatomical study says no area is absolutely safe, and no layer has been shown to suit everyone.
- Injection points and techniques, such as the gunshot technique with a needle down to bone, the fan technique with a cannula under the skin, or interfascial placement with a cannula, come from small studies or a trainer's opinion, with no direct head-to-head comparison found. A 20-person randomized trial found that hyaluronic acid alone kept more volume at 90 days than a hyaluronic acid and calcium hydroxylapatite mixture.
- Filler entering a blood vessel is a serious risk anywhere on the face, including the temple. Unusual pain, blurred vision, white, gray or blue skin, or stroke-like symptoms need immediate medical care. The 9 to 18 months quoted by the clinic has no independent source.
What are temporal fillers, and what causes sunken temples?
The clinic explained that the temples are part of the facial structure. When the temples are sunken or hollow, the face can look stern, the cheekbones overly prominent, and appear tired or older. Temple fillers involve injecting a filler substance into this area to give the face a more balanced look.[1]
Anatomical descriptions in the Plastic and Reconstructive Surgery Global Open (Idone et al.) indicate that full temples are a characteristic of youth and good health. As we age, the temples lose their convex shape, becoming sunken, revealing the prominent temporal bone ridge and cheekbone line, resembling a skeletal structure.[3]
The clinic explained four possible causes of temple headaches.[1]
- Temporal bone collapse
- Subcutaneous fat atrophies.
- Loose fascia and tendons in the temporal area.
- Decreased lateral lifting force of the face (lateral lifting deficiency).
The research I reviewed indicates that age-related volume loss leads to increased bone visibility, but it doesn't break down the proportions of the four contributing factors, so it's not yet possible to determine the significance of each factor in an individual.[3]
The same study categorized temple recession into three levels, measured from the deepest point of the temple to the tangent line passing through the outer corner of the eyebrow. The table below summarizes the criteria and average filler volume per side used by the author in their patient group, based on data from a single study and not standard volumes.[3]
| level | Characteristics of the temples. | Average filler volume per side in the author's work. |
|---|---|---|
| Level 1 | The shape of the temples begins to flatten, but is not yet concave. | There is no information available for this work. |
| Level 2 | It begins as a shallow depression, with the deepest point located 0–3 mm from the eyebrow tail line. | Approximately 1 ml.[3] |
| Level 3 | A pronounced indentation; the deepest point is more than 3 mm away from the eyebrow tail. | Approximately 1.5 ml.[3] |
A summary for the general reader before understanding injection molding.
“"Injection layer" refers to the layer of tissue where the doctor places the filler. The temples are not just a single layer of skin attached to the bone. Autopsies in six cases by Idone et al. found 11 layers of tissue from the skin down to the periosteum, with several layers of intramuscular fat.[3] The following are key points that general readers should know:
- The layer injected affects both the appearance and the risk. The clinic explained that superficial layers are at risk of forming lumps or lumps, while deeper layers are closer to important blood vessels.[1]
- Anatomy concludes that there is no area on the face that is absolutely safe. What can be done is to choose a layer with fewer blood vessels, while still being mindful of nearby veins and nerves.[3]
- In addition to choosing the right layer, the injector must also select the equipment, speed, and amount per injection. Safety reviews recommend blunt needles, small syringes, backfilling, slow injection, and low pressure.[5]
- Data regarding the optimal injection site is still inconsistent. Clinical guidelines, anatomical studies, and safety reviews vary, which is why physicians must assess each individual case.
- Warning signs that require immediate medical attention include unusual pain, blurred or altered vision, skin at the injection site turning white, gray, or blue, and symptoms similar to a stroke.[2]
How do injection layers, injection points and techniques differ for temple filler?
This section covers three separate things: the layer in which the filler is placed, the point where the needle or cannula enters, and the technique used to place the filler. The clinic describes 3 injection layers for the temple.[1] The work of Idone et al. identifies three layers in the literature as suitable for injection: subcutaneous, deep temporal fascia, and submuscular temporal layer above the periosteum.[3] Below is a breakdown of each layer, separating what the clinic describes from what independent sources state.
Subperiosteal layer
The clinic explained that this technique involves placing filler above the periosteum, typically using a sharp needle or injecting it as a single bolus to add structure and help lift the eyebrows. Caution is advised as it's located near the temporal artery and deep temporal veins, and is not suitable for those seeking a smooth, even appearance across the entire temple.[1] In safety reviews, it is recommended to inject into bone or a very superficial layer rather than subcutaneously because the subcutaneous layer often contains blood vessels.[5] Regarding the claim that this layer helps to raise eyebrows, no independent source was found to confirm this in the reviewed work.
Interfascial layer
The clinic explained that this layer lies between the superficial and deep fascia of the temporal lobe. A blunt needle (cannula) is used to reduce the risk of injecting into a blood vessel. It's suitable for filling and blending seamlessly with the forehead and cheekbones. A medium to high viscosity filler should be chosen.[1]
Idone et al. chose this layer as the primary technique, using a sharp needle to make an incision near the temporal bone ridge. A blunt needle was then inserted down to the periosteum before rotating into the interstitial layer. The injection was slow and steady. The authors explained that this layer contains loose fat and tissue and has relatively few blood vessels, yet a sentinel vein was still present in all dissected specimens, and the facial nerve branch is located above this layer, requiring caution.[3] The authors used a highly cohesive and rigid HA filler (cohesivity 2.6 Ns, G′ 290 Pa) in 57 patients and reported no major complications in the retrospective analysis group.[3] However, this is a retrospective study in which the authors report the results of their own technique, there is no control group, and the authors themselves state that more work is needed. Therefore, it is not evidence that this layer is safe for everyone.
Subcutaneous fat layer
The clinic explained that this layer is often injected with a blunt needle to distribute filler, helping the temples appear fuller and smoother. However, it carries the risk of lumps or ridges if the filler is not distributed well, and this layer should not be injected alone.[1] No independent sources have been found that directly compare this layer to other layers, but safety reviews indicate that the subcutaneous layer is the layer that typically contains blood vessels.[5]
Temple filler injection points: where is the filler injected?
The injection point here means the position where the needle or cannula enters the temple, which is different from the layer, meaning depth. The sources that could be read do not give a single standard position. The injection point depends on the technique and the layer chosen. The table below summarizes the points each source reports.
| Technique reported | Entry point given by the source | Instrument and layer | Limits of the source |
|---|---|---|---|
| Gunshot or Swift point | Mark the lateral orbital rim and the temporal fusion line, then apply the “one up, one over” rule: 1 cm up the line and 1 cm lateral. The superficial temporal artery is palpated first and the point can be adjusted.[10] | Sharp needle, down to bone, then a bolus above the periosteum[10] | A training-provider article quoting one trainer. Not a study. |
| Interfascial with a cannula | The superior border of the zygomatic arch, toward the front. The cannula enters at 90 degrees until its tip touches the periosteum, is then turned into the interfascial layer toward the temporal ridge, and is pulled back to place a bolus of about 0.2 mL at the center of the temple.[8] | 22G, 50 mm blunt cannula, interfascial layer, with ultrasound confirmation of the layer[8] | 20 patients, no comparison group, authors have ties to the filler company used. |
| Fan technique under the skin | Entry about 10 mm above the zygomatic arch, opened with a 24G needle[9] | 22G cannula, 5 retrograde threads 0.5 cm apart, 0.1 mL each, in the subcutaneous layer[9] | Randomized trial of 20 people, 90 days, compared filler types, not techniques. |
| Interfascial in the anatomical study | Near the temporal ridge, opened with a sharp needle before the cannula is passed[3] | Blunt cannula down to the periosteum, then turned into the interfascial layer[3] | Retrospective, no comparison group. |
What these sources agree on is the need to avoid vessels, but they name different at-risk structures, such as branches of the superficial temporal artery, the vein found in the interfascial layer (the sentinel vein), and the deep temporal arteries in the subperiosteal layer.[3][8][10] No study comparing these entry points directly was found, so it should not be assumed that any one point is safer.
Temple filler injection technique: what techniques are there?
The technique is how the filler is placed, for example as a bolus, as retrograde threads or a fan, and with a sharp needle or a blunt cannula. The sources that could be read describe three main approaches, covered in the subsections below.
What is the gunshot technique (Swift point)?
A common search is “gunshot technique temple filler”, which asks what the technique is. A Harley Academy training article explains it as a needle technique devised by Arthur Swift (also called the Swift point) used to fill the temporal hollow. The needle tip goes down to bone to place a bolus of filler above the periosteum, avoiding branches of the superficial temporal artery, and the filler is injected slowly using a medium to high G′ product. The trainer quoted says that in her own practice she uses no more than 0.3 mL per bolus and no more than 0.5 mL per temple per side, and splits larger volumes across visits about 4 weeks apart.[10]
The same trainer says aspiration should not be relied on alone to confirm the needle is outside a vessel, that many experienced practitioners advise large blunt cannulas or ultrasound guidance in the temple because it is a high-risk area for vascular occlusion including blindness, and that the technique should be attempted only after rigorous anatomy training and supervised injection practice.[10] Bravo and colleagues state that supraperiosteal injection can restore a lot of volume but risks the deep temporal arteries, the filler can shift when the temporalis muscle contracts, and more product is needed.[8] All of this is the description of a trainer and of the authors of a small study. No study directly comparing the gunshot technique with other techniques was found.
Fan technique with a blunt cannula in the subcutaneous layer
The randomized trial by Germani and colleagues in Aesthetic Surgery Journal Open Forum (2025) opened an entry with a 24G needle and then injected with a 22G blunt cannula in the subcutaneous layer in a fan pattern: 5 retrograde threads 0.5 cm apart, 0.1 mL each, 0.5 mL per side in total. The authors chose this layer by citing anatomical work reporting fewer vessels than in the deeper planes.[9] That differs from the safety review, which says vessels are often found in the subcutaneous layer,[5] which is another example of sources not agreeing.
Interfascial technique with a cannula and ultrasound
Bravo and colleagues reported in Frontiers in Surgery (2025) that 20 patients aged 26 to 75 received a high-viscoelastic hyaluronic acid filler into the interfascial layer through a blunt cannula from the upper border of the zygomatic arch, with ultrasound confirming that the filler was in the intended layer in every patient. The authors report no serious adverse events or hematomas, mostly mild pain, and moderate pain in 2 patients.[8] The limits are that there was no comparison group, the authors say separating the two fascial layers on ultrasound can be difficult in some patients, and two authors are speakers for the manufacturer of the filler used, so more work is needed before concluding it is safer than other techniques.[8]
The pinch technique is used to avoid blood vessels.
Kapoor et al. explained that using the other hand to grasp or pull the tissue during injection can alter the position of blood vessels. Some vessels are pulled up within the grasped layer, while others remain stationary, creating space for injection by separating the mobile layer from the rigid one. The authors suggest that this knowledge helps injectors avoid blood vessels and place the filler in the correct layer.[4] The available information is in the form of an abstract, therefore the details or extent of the evidence are unknown.
| Injection layer | What the clinic explained. | What independent sources indicate. | Caution |
|---|---|---|---|
| Bone-in layer | Adds structure, helps lift the eyebrows, can be done with a sharp needle or injected as a lump.[1] | It is one of the classes that has been reported in the literature, and safety reviews recommend injection into the bone or superficial layer.[3][5] | Near the temporal arteries and veins; no confirmed source found regarding eyebrow raising. |
| Interstitial layer | Use a blunt needle to fill in and blend it smoothly, creating a seamless look with the forehead and cheekbones.[1] | This is a technique reported by Idone et al. in retrospective patients. The authors found no major complications.[3] | It also involves veins and nerve branches. It's a small-scale study with no control group. |
| Subcutaneous layer | Using a blunt needle helps to make the temples appear fuller and smoother.[1] | It is one of the layers that has been reported, but it is the layer that usually contains blood vessels.[3][5] | There is a risk of lumps or lumps; this layer should not be injected alone. |
Risks of temple fillers: warning signs and immediate actions to take.
The clinic explained that improper injection techniques carry several risks, including filler migrating to the forehead or jawline, resulting in an unnatural facial shape; injecting too deeply, risking damage to an important superficial temporal artery; using the wrong type of filler, leading to lumps or abnormal swelling; and injecting too shallowly, resulting in lumps or ridges.[1]
A review of post-filler vision loss identified the temporal area, specifically the superficial temporal artery and medial temporal vein, as a high-risk area. It concluded that all areas of the face are susceptible, and even experienced physicians may encounter this condition.[5] In the compiled reports, the most common injection sites were the nose, forehead, and between the eyebrows.[5][6] This is a proportion in the reported patient group, not a risk per single injection, and does not mean the temples are safer.
The FDA states that the most concerning risk is accidental ingestion of fillers into blood vessels. Although the chances of this happening are low, the consequences can be serious and potentially permanent, such as tissue death, vision loss or even blindness, and stroke.[2] The FDA lists the areas approved for volume enhancement on the page you'll be reading: lips, cheeks, chin, and back of the hand. The temples are not mentioned, and the same page lists different indications depending on the product, suggesting the FDA may not have yet reviewed use on certain locations.[2] Therefore, it is advisable to ask your doctor which product is suitable for the temple area. (This information is from the US FDA and does not specify its status in Thailand.)
Warning signs you should be aware of.
| Syndrome | Characteristics as specified by the source. |
|---|---|
| Abnormal pain | The FDA recommends seeking immediate medical attention if you experience any unusual pain during or shortly after the injection.[2] |
| Vision and the eyes | Changes in vision, blurred vision, ptosis (drooping eyelids) (56.2%), and inability to move the eyes normally (44.1%) were reported in patient vision loss cases collected between September 2018 and March 2023.[2][6] |
| Skin color changes | The skin at the injection site will turn white, gray, or blue.[2] A 2014 review noted that pale white skin, a livedo pattern, slow blood return, and purplish-red discoloration may be observed, followed by blisters and subsequent skin peeling.[7] |
| Similar to a stroke. | Difficulty speaking suddenly, numbness or weakness in the face, arms, or legs, difficulty walking, drooping face, severe headache, dizziness, or confusion.[2] |
Regarding outcomes, a 2024 review encompassing 318 patient reports indicating visual outcomes found that 6.0% had full recovery, 25.8% had partial recovery, and 68.2% had no recovery. No treatment was found to be significantly associated with improvement.[6] Therefore, you shouldn't wait to see if the symptoms will go away on their own.
What should you do if warning signs appear?
- Tell the administering physician immediately to stop the injection. The FDA states that recipients must stop the injection immediately if they experience pale skin, changes in vision, symptoms resembling a stroke, or unusual pain.[2]
- If you experience any eye symptoms or symptoms similar to a stroke, go to the emergency room or see an ophthalmologist immediately. A review indicates that vision loss from fillers requires immediate referral to an ophthalmologist.[2][5]
- If your skin changes color or becomes unusually sore, return to the doctor who administered the injection or a dermatologist as soon as possible. A review indicates that early detection and prompt administration of hyaluronidase are key to successful treatment.[7]
The risks of fillers near the eyes can be found in this article. Is it true that you can go blind if you get filler injections under your eyes?
How to choose a filler for the temple, how long it lasts, and how much is used
Best dermal filler for temple area: how is a filler chosen?
A question people search is what the best dermal filler for the temple area is. Among the sources that could be read, no study identified a best product for the temple, and none compared brand against brand directly. What was found are the properties the sources use when choosing.
- Material and reversibility. Hyaluronic acid (HA) fillers can be dissolved with hyaluronidase if a complication occurs. Calcium hydroxylapatite (CaHA) cannot be dissolved, although it is still used in risky areas such as the temple.[7][9]
- Firmness and viscosity. Idone and colleagues used a highly cohesive, firm HA (cohesivity 2.6 N.s, G′ 290 Pa) in the interfascial layer.[3] Bravo and colleagues used a high-viscoelastic HA with a cannula in the same layer.[8] The Harley Academy trainer recommends a medium to high G′ product for a bolus above the periosteum, and says a softer product and massage may be needed if a shallow layer is injected.[10] he clinic explains that the interfascial layer calls for a medium to high viscosity filler.[1]
- Approval status. The FDA page that could be read does not list the temple as an approved area for volume enhancement, so it is worth asking the doctor how the product suits this area.[2]
A randomized trial by Germani and colleagues compared HA alone with a mixture of 40% HA and 60% CaHA, prepared by hand by passing the products between syringes, in 20 patients (40 hemifaces), 0.5 mL per side, injected subcutaneously with a cannula in a fan pattern and followed for 90 days. Both groups improved significantly on the temple hollowing scale, with no difference between groups at 90 days (P = 0.694), but 3-dimensional measurements showed HA alone kept more volume (0.231 ± 0.255 mL versus 0.028 ± 0.135 mL, P = 0.016). The authors concluded that no synergy from the mixture was seen. No serious adverse events occurred, only mild swelling and bruising that resolved on their own within a few days.[9]
The limits of this study are a small sample, only 90 days of follow-up, no patient-reported outcomes, and no check of how evenly the hand-mixed product was blended. One author is a speaker for the manufacturer of the products used.[9] The result therefore only says that this way of mixing did not keep more volume than HA alone at 90 days. It does not answer which material is best in the long run. The choice should take into account the grade of hollowing, the layer and technique the doctor uses, reversibility, and the experience of the injector together.
How long do temple fillers last, and how much is needed?
The clinic states that temporal fillers last 9–18 months, depending on the type of filler and post-injection care.[1] The FDA states that the duration of the effect depends on the filler material and the injection site.[2] In this independently available source, no studies were found that specifically measured the 9–18 month period at the temples.
The work of Idone et al. reported that in the retrospective follow-up group, the median follow-up period was 14 months, and no patients required additional fillers, with an average of approximately 1 ml per axon in level 2 temporal arteries and 1.5 ml per axon in level 3 arteries.[3] These figures are limited to the products, techniques, and patient groups of the authors. They are retrospective assessments, use satisfaction questionnaires, and do not include a control group. The authors themselves state that more work is needed before broader conclusions can be drawn, and therefore these figures should not be used as guaranteed timeframes or quantities for individuals.
The authors also reported that no bruising or swelling was observed in the analyzed groups, and two out of 15 patients in the level 3 group experienced mild pain 48 hours after the injection.[3] However, the FDA states that swelling and bruising are common side effects of fillers in general, and some may occur weeks, months, or even years after injection.[2] Therefore, one should not expect there to be no side effects at all.
How to prepare and choose a doctor before getting temple filler injections.
The FDA recommends choosing a licensed provider with experience in dermatology or cosmetic surgery, and that filler injections be considered a medical procedure.[2] Here are some questions you should ask before getting a shot:
- What is the level of my temples, and would filler be suitable for them? Are there other options?[3]
- Which layer and point will be used, with which technique (for example a gunshot with a sharp needle, a fan, or interfascial with a cannula), and why?[3][5][8][10]
- Which filler is used, how firm is it, can it be dissolved with hyaluronidase, can I see the label or package insert, and how does it suit the temple?[2][9]
- Do you have a plan in place and are ready to administer hyaluronidase or refer patients immediately if any warning signs occur? The FDA states that recipients of these injections should have such a plan.[2][7]
- Personal precautions include conditions such as inflammation or infection of the skin in the area, bleeding disorders, history of severe allergies, pregnancy, or breastfeeding, which the FDA has stated should be disclosed to a doctor or whose safety is still unknown.[2]
Read more about fillers in other areas in our articles. Orange Cheek Filler and chin filler
FAQ (Frequently Asked Questions)
Q: What is temple filler, and what causes hollow temples ?
Q: Which layer of the temples should I get filler injected into?
Q: Where are the temple filler injection points ?
Q: What is the gunshot technique for temple filler, and how does it differ from other techniques ?
Q: What is the best dermal filler for the temple area, and how long does it last ?
Q: What are the risks of temple filler, and which symptoms need a doctor immediately ?
Conclusion
Temple filler restores volume to temples that have hollowed with age. The injection layer, injection points and technique, such as gunshot, fan or interfascial, affect both appearance and risk, but the evidence that could be read is still small anatomical work, clinical reports with no comparison group, a trainer's opinion and safety reviews that do not fully agree, and no study identifies a best filler for the temple. Filler entering a blood vessel can cause tissue death, blindness or stroke, and anyone with unusual pain, blurred vision, skin color change or stroke-like symptoms after injection needs a doctor immediately.
At Fresh Code Clinic, doctors assess the degree of temple sunkenness, facial structure, and individual goals before planning injections. The information in this article is for general knowledge purposes only and is not a diagnosis or guarantee of results. For more information, consult a doctor for a pre-assessment.
References
- Temple Fillers: Injection Techniques and Injection Layer Selection (Original Article) — Fresh Code Clinic
- Dermal Fillers (Soft Tissue Fillers) — US Food and Drug Administration
- Temporal Fossa Atrophy in Aesthetic Medicine: Anatomy, Classification, and Treatment — Plastic and Reconstructive Surgery Global Open
- Pinch anatomy: An injection guide for temple filler injections — Dermatologic Therapy
- Visual loss after aesthetic facial filler injection: a literature review on an ophthalmologic issue — Arquivos Brasileiros de Oftalmologia
- Update on Blindness From Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases — Aesthetic Surgery Journal
- Complications of injectable fillers, part 2: vascular complications — Aesthetic Surgery Journal
- Leveraging anatomy to improve safety and efficacy in temple augmentations: a case series of 20 patients — Frontiers in Surgery
- A Randomized Clinical Trial Comparing Pure Hyaluronic Acid to the Hyaluronic Acid–Calcium Hydroxylapatite Combination for Temporal Volumization — Aesthetic Surgery Journal Open Forum
- What is the Gunshot Technique for Injecting Filler? — Harley Academy
