Temporal filling is a surgical method to improve the face shape by filling the temporal skin under the skin tissue with autologous tissue or artificial material to rectify the narrow forehead and temporal depression.
I. Surgical method
The surgery is performed under local anesthesia.
1.Granular fat filling, 16-gauge injection needle and disposable 10 ml plastic syringe, abdominal wall liposuction. After physiological saline rinses the granular fat, 10-15 ml of granular fat is injected subcutaneously into the temporal area unilaterally each time. Appropriate postoperative pressure bandage was applied.
2.Sheet ePTFE and Medpor filling, a longitudinal incision is made in the temporal region 4-5 cm from the hairline, 3-5 cm long. the skin and subcutaneous tissue are incised, and then the cavity is separated on the superficial surface of the superficial temporal fascia. The filling ePTFE sheet is trimmed to the desired size and thickness, the edges are thinned, and traction is applied to the cavity with a straight needle line. Alternatively, a suitable cavity can be isolated between the deep temporal fascia and the temporalis fascia, and a trimmed Medpor block can be placed. The incision is closed in layers and bandaged with pressure.
II. Analysis of the anatomical level of frontotemporal fillings
There are four safer anatomical levels for temporal fillers.
① Subcutaneous, superficial surface of superficial temporal fascia;
(2) The subcapsular layer of loose connective tissue, but not more than 1.5 cm above the horizontal limit of the zygomatic arch;
③between the deep layer of deep temporal fascia and temporalis muscle membrane;
(iv) the subperiosteum of the temporal region.
The above four anatomical levels are the safer filling levels in the temporal region. Because of the relatively small amount of subcutaneous fat in the temporal area, the texture of the lumpy material filling at the first level is poor, and it is easy to form the material contour protrusion. Because there are deep temporal fascia and periosteum firmly attached at the upper temporal line, the 3rd and 4th levels are separated from the same level of the frontal area, therefore, in patients with forehead stenosis with a slight forehead protrusion or triangular head shape, the single filling of these two levels can form a frontotemporal junction cut, and the frontotemporal transition is not smooth.
In view of the fact that the temporal branch of the facial nerve passes in the lower part of the temporal area at the 2nd level, the combined application of the 2nd and 4th levels is often adopted, i.e., subcapitellar filling of the frontotemporal junction and subperiosteal filling of the temporal area. This method is suitable for patients with forehead stenosis with forehead protrusion and triangular head shape, especially for small incision filling with granular artificial materials.
The relationship between filling materials and efficacy
Autologous granular fat, HA, ePTFE, Bioglass, Medpor all have good biocompatibility, almost no toxic side effects, and can accompany with human body for a long time. Therefore, there are few complications caused by these materials themselves.
The main adverse reactions after surgery are.
① Partial absorption of granulated fat after surgery;
②Insufficient filling volume at one time due to underestimation before surgery, influence of local anesthesia during surgery, and new requirements of patients after surgery, etc;
(3) The placement of the lumpy filling material is too shallow and the edges are step-like.
In conclusion. The granular fat has the same texture as the subcutaneous tissue of the recipient area, and its postoperative texture is the best, followed by ePTFE. the deeper the filling level, the better the texture. The granular material is simple, safe, less invasive, easy to shape, and more acceptable to the patient, and has a better postoperative texture. Considering various factors, granular fat is still considered to be the best material for frontotemporal filling surgery.