Carolina Facial Plastic Surgery

Facial Filler Injections To Temples

Dr. Kulbersh

Facial Filler Injections To Temples With Expert Facial Plastic Surgeon, Dr. Kulbersh

Dr. Kulbersh: This is Dr. Kulbersh from Carolina Facial Plastics. Today, we’re actually going to have a special video blog with one of my favorite patients, Jeff. Jeff is actually five weeks after his rhinoplasty. And Jeff had a droopy tip and a little bit of a hump. So, we raised the tip of his nose to tone down his hump slightly. And at five weeks, he has a little bit of swelling left, but we are both really ecstatic with the results.

But on a different note, Jeff is actually here for a different reason for today. Jeff has some hollowing in the temple area. And with the face, we’d like to move the face and see how light plays on the face. And when we have hollowing in the temple area, we get some convexity. And convexity causes shadowing or darkness. And it just doesn’t give a nice flow of the face, or the upside down egg-look as I like to call it on it the face. And so we want to take that area, and add volume to it and make it convex. So instead of having shadowing, we’re actually going to have light reflecting off of that area of the face; the temples. This is going to be a much more awake-looking appearance. It’s just going to make his whole face and his eyes look better. So, just looking at Jeff, everybody has a little bit of volume measure changes that you saw in the face. Between his left temple and his right temple, he has more volume loss over here in the right side. And we just have to notice that when we’re using our fillers, we’re just going to have to use a little bit more volume over here to help give Jeff the best symmetry that we know how to. The temple is an area above the zygomatic arch which is this boney area. It’s supposed to be filled with a muscle in this area that’s called a temporalis muscle and that muscle goes and helps us close our mouth. There’s also a series of fatpads that are in this area, and that seems to be the main issue in that we lose some volume in that fatpad.

So today, we’re doing the injectable filler with the canula. We’re going to revolumize this area with Perlane, which is a hyaluronic filler to give him more of his natural concavity, kind of smoothes across there, and it’s just going to make his whole face look better. So, looking at Jeff, we’re just going to mark out where his volume loss is. And today we’re going to be doing, what I call my needleless injection technique with filler, or using the canula. So, what we first do – and this is just a little bit of numbing medicine – a little baby shot – this is just going to be a little shot of lychene – this is just to numb the very end of the skin. So, Jeff can just tilt back his head – this is going to be a little tiny baby shot. And through this one little hole – this one little area of numbing we’re actually going to fill the whole area. We’re going to take a very small needle. This is going to make a small hole through the skin to where we can put our blunt canula. And this needle goes barely in the skin and Jeff won’t even feel this, because the skin is already numb. Barely goes in. And we have our Perlane, and instead of injecting the thin needle, we have a long blunt, canula on the end. And the Canula, instead of being sharp, with the bluntness, it will actually just push, through the tissues in the skin so it causes less trauma, less bruising, and is more comfortable. In my hands, I get superior results, as opposed to using a needle to inject fillers in the face.

So, to get this, we pinch the skin like this, we’re going to do a little tunneling, a little fanning technique, and so this is just pushing all the tissue out of the way – just much more comfortable for the patient. The filler itself actually has numbing medicine in it. So, as we start, this is the most uncomfortable part, but it will all get better the more we do it. And you can just see we’re slightly picking up and filling the area. So, since the canula is pushing the tissues out of the way, you’ll see when it gets to a hard part, you’ll see the skin bunch up and that’s because it doesn’t slide through like a needle. So, that’s completely normal. That’s completely how it always go when you do a filler – you’ll see the skin – actually you can see the nice fills that come back. You just saw it right there. You can see the needle right here and then you’re just going to see the nice fill. And I’m just working my way around to fill the whole area. We’ve already started getting some good volume in the area and we’re going to keep filling this area, till we get it nice, smooth and even. We’ve still gotta fill – we’re going to come in through this hole, to inject the rest of the temple area. And then, we’ll keep working to fill this whole temple area. This is a great example of how we use the blunting canula to fill the temple area, It’s a very satisfying, a very comfortable way to inject the temples. Using the canula, I feel like you get less bruising, less bleeding and get superior results. We’ve just completed filling the left side of his temple. This is immediately afterwards, and now we can see we’ve got nice volume on the left side of his temple. You can see it’s got just a little bit of swelling where I put the medicine in where I placed the canula to do the filler… that will go away in about one hour. But instead of having the indentation like he does on this side of the face, there’s now a smooth transition from the cheekbone up into the cranium. So, it just gives him a nice, smooth look and it’s just a really refreshing appearance in his face. And it was relatively pain-free. Don’t really have much discomfort to it. And it took us about 15 minutes to do one side. And now we’re going to fill the other side to give Jeff the symmetrical look he’s looking for. What’s unique about filling the temple is that a lot of people are hesitant to fill the temple because there are some blood vessels in the area that they are afraid to injure. Since I use the canula, I feel much more comfortable filling this area because the canula, when it gets near the blood vessel it’s going to push it out of the way instead of cutting it or injuring it. So that’s why with my technique, I feel much more comfortable filling the temple region.

We’re going to go ahead and demonstrate this one more time. And you do hear a little popping, a little pushing, and that’s because the canula, instead of cutting through tissues, it’s just pushing it aside. So that’s always normal, and I always tell patients you’re going to feel, you’re going to hear weird things; you’re going to maybe feel a pop and that’s all normal. And we’ll continue to go through these two holes with the canula to fll in the temple area. And that’s how I do at Carolina Facial Plastics – I fill the temples with a canula technique. Jeff is very pleased with the results of the new volume in his temple area. He has very little bruising, bleeding. He’s got a little redness from just wiping on the skin with the alcohol but he should be fine to go out tonight and enjoy his thanksgiving weekend. And overall I have to say today was a great success and we are both very pleased with the results. Thank you.

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