Temporal filling is a relatively common cosmetic surgery of the head and face, but there are many opinions about the level of material implantation, and many scholars advocate implanting deep temporal fascia. We have been using the deep temporal fascia superficial level of forming silicone prosthesis implantation, experienced that this operation is easy to operate, the effect is exact, and safe and reliable, not easy to appear facial nerve temporal branch injury. 1.Surgical method: The patient is placed in a sitting or lying position, and the range to be filled is drawn with a marker to estimate the thickness of the implant to be filled. At the same time, the main trunk and frontal branch of the superficial temporal artery and the course of the parietal branch are palpated by palpation and drawn with a marker. A surgical incision line of approximately 3 cm in length is made in the hairline parallel to the edge of the implant at a distance of 2 to 3 cm above the marked area to be filled. The incision should be positioned so as not to injure the temporal and parietal branches of the deep superficial temporal vessels, and it is more appropriate to position it between the temporal and parietal branches of the superficial temporal vessels. After disinfection and spreading of the towel, the silicone prosthesis is taken and trimmed appropriately, and the size of the prosthesis is consistent with the extent and shape of the body surface markings. This allows for a natural transition of the implanted prosthesis edges, which should be trimmed with thin edges prone to curling. Local infiltration anesthesia is applied at the incision site, and the entire scalp is incised, and the deep temporal fascia layer can be clearly seen by propping up the incision. The blunt injection needle (choose the injection needle for fat aspiration, the one with a single lateral opening at the head end is better) is used to reach the surface of the deep temporal fascia layer directly through the scalp incision, and the injection is made while sliding along this layer toward the implantation area. About 30 ml or more of local anesthetic solution should be injected on one side. The local anesthetic solution is usually prepared as follows: 10 ml of 2% lidocaine, 90 ml of saline, and 0.1 ml of epinephrine, totaling about 100 ml. The cavity should be of the same size as the marker and should not be enlarged, but the cavity should not be isolated by strips or fibers. This procedure is a blunt separation under blind vision. Note any obvious active bleeding, and if so, apply local pressure to stop the bleeding. The silicone prosthesis is placed through the incision and the edges of the prosthesis are visible by pulling on the incision to see if they are in line with the body surface markings. To ensure that the placement of the prosthesis is accurate, a small notch is formed at one edge of the prosthesis when it is trimmed, so that it can be placed in line with the incision for easy observation and determination. A skin slice is placed under the scalp for drainage and the scalp is closed with full sutures. If upper blepharoplasty or midface wrinkle removal is to be performed at the same time, the aforementioned procedures are performed first, and botulinum toxin injections are performed postoperatively. The area is covered with a gauze pad or cotton pad and wrapped with an elastic bandage under pressure. The pressure bandage was applied for 3 days, and the drainage skin piece was removed 3 days after surgery. 2. Clinical data: A total of 47 cases of temporal fillers were collected from January 1999 to December 2007, with a total of 94 sides, aged 21 to 45 years, 42 women and 5 men, 35 cases of simple temporal fillers, 2 cases of simultaneous upper lid blepharoplasty, 2 cases of upper lid skin laxity correction, 5 cases of simultaneous botulinum toxin facial injection, and 3 cases of simultaneous midface wrinkle removal. The implant materials used were all solid silicone, soft in quality, from Shanghai Corning Silicone Products Co. 3. Results: The surgery went smoothly in all cases. After the operation, there were 2 cases of local hematoma, which was aspirated by a syringe and bandaged with pressure, and the operation effect was not affected. Temporary incomplete paralysis of the frontalis muscle occurred in three cases on each side in the early stage, and the symptoms disappeared within three weeks. After follow-up from 3 months to 2 years after surgery, 40 patients reported that they were satisfied with the surgical results and had no local discomfort or other symptoms. In two cases, there was recurrent local swelling and mild redness on both sides within six months after surgery, and the symptoms were reduced by taking antibiotics, one of which disappeared after removal of the prosthesis, and the other case was filled with expanded PTFE after removal of the prosthesis, and the symptoms improved. In three cases, the patients claimed that the filler was insufficient and did not meet the requirement of fullness of the temporal area. Two cases showed occasional filling of the temporal subcutaneous veins on one side, which was more obvious than before surgery and had poor appearance. None of the cases had permanent damage to the temporal branch of facial nerve. 4. Discussion: Excessive narrowing of the frontotemporal region compared with the width of the zygomatic prominence on both sides causes aesthetic visual problems, and such patients usually need to be corrected by augmentation temporal surgery. Previous reports on the surgical approach of augmentation temporal surgery have varied on the level of placement of the prosthetic material. Although it has been suggested that there are four safer anatomical levels as follows: ① subcutaneous frontotemporal area; ② subcapsular tendon membrane layer of loose connective tissue, temporal area is between superficial temporal fascia and superficial deep temporal fascia; ③ between deep deep temporal fascia and temporalis muscle membrane; ④ subperiosteal temporal area, but many scholars advocate that deep temporal fascia should be implanted. In our clinical application, we found that placing the implant material between the deep temporal fascia and temporalis muscle is safe but has the following disadvantages: ① The deep temporal fascia is a rather dense tendon-like structure, and its extensibility is different from that of soft tissues such as skin, so it is not easily augmented by the prosthesis. When the prosthesis is placed under the deep fascia, the degree of augmentation of the superficial tissues is limited because the dense deep fascia and the underlying muscle fibers are obviously different in their extensibility, which easily presses the prosthesis down to the depths and does not easily augment the superficial layers; ② The separation at this level must be performed under direct vision, unless it is possible with a coronal scalp incision that fully exposes the temporal region, otherwise a larger skin incision needs to be designed and close to the (3) The prosthesis placed in the deep temporal fascia is directly pressed on the temporalis muscle, which may atrophy under long-term pressure, affecting the function of the temporalis muscle and reducing the augmentation effect. When analyzing the temporal depression caused by coronal incision after surgery, some scholars found that the deeper the temporal part is separated from the level, the more serious the temporal depression occurs. For subcutaneous fillers, we believe that if the temporal depression is only mild, fat particles injection at the subcutaneous level can be considered, and prosthesis is not suitable to be placed in the superficial subcutaneous layer. Biomaterials are used in various plastic and cosmetic surgeries and in principle should be safer on the deeper side of the soft tissue. The thinner the surface layer of the prosthesis, the greater the chance of postoperative complications, such as prosthesis outgrowth and prosthesis movement, and poor local tactile sensation. Subperiosteal prosthesis placement is very traumatic, difficult to separate, bleeds a lot, and the size and shape of the prosthesis are not easily estimated accurately. The biggest concern in the past about placing the prosthesis in the superficial surface of the deep temporal fascia was the injury to the temporal branch of the facial nerve. After the temporal branch of the facial nerve exits the parotid fascia, it crosses upward over the zygomatic arch and enters the middle temporal fascia. The middle temporal fascia is a layer of fatty fascial structures composed of loose connective tissue and can actually be considered as a potential cavity between the superficial temporal fascia and the deep temporal fascia, and the temporal branch of the facial nerve travels in this layer. The temporal branch of the facial nerve is located close to the surface of the periosteum in the zygomatic arch and is deeper. It gradually moves upward to the superficial surface and reaches the innervated muscles such as the frontalis muscle, orbicularis oculi muscle and the ear muscle one after another. Temporal plastic surgery is easy to hurt the temporal branch of the facial nerve in two areas: one is close to the zygomatic arch, too close to the deep separation of the zygomatic arch to damage the nerve; the second is the lateral orbital nerve terminal branch from the orbicularis oculi and frontalis muscle deep surface into the muscle, where the superficial separation may also hurt the nerve. (1) When injecting local anesthetic solution, use a blunt-tipped injection needle with a single lateral hole to fully expose the deep temporal fascia under direct vision, with the needle firmly against the deep temporal fascia and the needle opening facing the deep surface, slide obliquely toward the intended implantation area, and inject while advancing, and when approaching the lateral orbital rim and the upper edge of the zygomatic arch The injection should be made close to the deep temporal fascia. The volume of local anesthetic injected on one side should be at least 30 ml. (2) It is recommended to use blunt-tipped curved scissors to separate the implantation cavity, as with the local anesthetic injection, and to separate the implantation cavity close to the surface of the deep temporal fascia, using blunt advancement as much as possible when approaching the lateral orbital rim and the superior edge of the zygomatic arch, instead of sharp cutting. (3) The edges of the silicone prosthesis should be trimmed thin to avoid compression and extrusion of the nerve branches by the overly thick prosthesis edges. The lower edge of the prosthesis should not extend beyond the upper edge of the zygomatic arch. We believe that this procedure has the following advantages: (1) The thickness and elasticity of the surface tissues are appropriate after implantation of the prosthesis, so that the filling effect can be better revealed and the undesirable contour of the prosthesis and foreign body reaction are not easily seen on the surface. (2) The incision is not only hidden in the hairline, but also only 3cm in length, and the incision is 2-3cm from the edge of the prosthesis, so it is not easy to have problems with the incision adjacent to the prosthesis, and the operation is relatively simple, with little trauma and quick recovery. (3), the separation is close to the surface of the deep temporal fascia, which is actually the lowest layer of the middle temporal fascia. Although the trunk and branches of the temporal branch of the facial nerve are close to each other, they are all distributed on top of it, and careful operation can completely avoid damaging the temporal branch of the facial nerve. Temporal filling is a more common cosmetic surgery, we recommend the use of shaped silicone prosthesis, placed on the surface of the deep temporal fascia through a small incision in the hairline, this procedure should become the preferred method of simple temporal filling.