Filler Injection Between the Superficial and Deep Temporal Fascia and Diameter of Superficial Temporal Arteries for Temple Augmentation: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background and aim</h4>With age, temple depressions appear due to age-related atrophy of fatty tissue, leading to a prominent cheekbone and lateral rim of the eye socket. Hyaluronic acid fillers have become very popular in the temple area due to their simple procedure and reliable results. The present study was conducted with the aim of determining the effectiveness of filler injection between the superficial and deep temporal fascia and the diameter of superficial temporal arteries for temple enlargement.<h4>Method</h4>The international databases PubMed, EMBASE, and Web of Science were searched using keywords aligned with the study objective up to July 2025. All articles were reviewed by two blinded, independent authors. STATA/MP.v17 (College Station, Texas, USA) was used to perform the analyses.<h4>Result</h4>Based on the findings of seven included studies, the efficacy of HA filler injection in the STF and DTF area showed an efficacy of 85% (ES: 85%, 95% CI: 81%-91%). According to subgroup meta-analysis, higher efficacy was observed with volume injection of 1.5 mL on each side (ES: 94%, 95% CI: 77%-100%). Subgroup meta-analysis showed that the 18-gauge cannula had the highest effectiveness (ES: 94%, 95% CI: 77%-100%).<h4>Conclusion</h4>For temple augmentation, hyaluronic acid filler injection between the superficial and deep temporal fasciae is a highly effective and safe procedure; it is also recommended to inject filler in small volumes and use 18-gauge and 21-gauge cannulas to target the supraperiosteal and supra-deep temporal fascia layers.