Tutorial: Mastering temple and glabella (frown line) fillers

Mastering the anatomy of the temple, glabella, and surrounding facial structures in the upper face is essential for safe dermal filler injections because complications can easily arise in this area without proper understanding. When treating complex cases, your approach should be led by the consultation, understanding what the patient is concerned by, and educating them on the underlying causes and treatment options.

In this blog, Dr Tim Pearce discusses a tutorial where he tackled a complex upper face treatment focusing on the temples and forehead. His goal was to blend previous treatments and address volume loss for a smooth, natural look in a patient with frown lines that had become resistant to botulinum toxin. The patient required a strategic approach to restore volume and enhance facial harmony. Watch Dr Tim’s full tutorial video demonstrating safe techniques for temple and frown line fillers.

If you are interested in learning more about facial anatomy to become a great injector and find your route to safer delivery and millimetre precision, get signed up for the Ultimate 3D Anatomy Experience from Dr Tim Pearce.

Medical professionals are taught anatomy in 2D textbooks, but in real life, anatomy is not flat. This educational opportunity is specifically for aesthetic injectors to help you level up your anatomy knowledge, get comfortable with anatomical variations, and boost your injection safety and confidence in a way that no cadaver course could ever deliver.

Get on the waiting list for updates when the Ultimate 3D Anatomy Experience goes live this summer.

Volume restoration filler injection techniques for the temples

In this case study, the patient had frown lines that had become resistant to botulinum toxin. Dr Tim noted that she needed volume underneath her glabella, something she had had many years previously via a different technique when he directly treated her frown lines. However, she also self-presented requesting volume replacement in the temples.

When you look closely, after correcting a temple, explained Dr Tim, you often see that the lateral frontal fat pad is also depleted. If you are aiming to achieve a smooth continuous shape along the forehead, you often need to treat the lateral frontal fat pad and the temples together, plus, sometimes, even the line that divides the two; if there is a shadow running along the temple crest, you fill underneath and above to make it one continuous smooth line, he noted.

The tutorial video demonstrates how to treat a risky area in what Dr Tim believes to be a safe manner, using cannulas, a lot of patience, and additional techniques when using a cannula that validate that it is not in a vessel, avoiding the chance of vascular occlusion.

His approach to treating the temple began with looking for avoidable risks, by using both an ultrasound scanner and manual palpation with his finger to check for vessels. He explained that he uses both methods – layering his risk assessment – because sometimes the ultrasound probe can be angled in the wrong direction, or you may squash a small vessel and not be able to see it on the screen, but you may indeed feel something with your finger. He also noted the transition, where the shadow forms, which is his aesthetic goal before choosing the entry point for volume restoration.

Dr Tim reinforced the need to know your anatomy for placement and to angle the needle in such a way that you can avoid serious complications if injecting too deeply, highlighting the dangers of injecting near the pterion, also known as the suture point, where the skull bones join. This is not somewhere you would inject because it is the weakest part of the skull, that can thin even further with ageing. In theory, putting a needle straight through that area would introduce filler into the cranium, he warned. He always injects in a way that would make that impossible, angling upwards, towards the frontalis, the angle of entry being continuous, hence if the needle were to go deep, it would be onto the frontal bone.

Having chosen the entry point and angle of entry, and following aseptic practices, Dr Tim demonstrated introducing the needle, touching the bone – which is not very deep in the forehead – and performing a long aspiration before dermal filler product placement, followed by a small massage to the area.

For additional insight on aspiration techniques read these blogs,

• Does aspirating work?
• Does ultrasound provide the evidence to support aspirating with fillers?
• How to increase your injection safety with this aspiration trick, and
• How many seconds should you aspirate for when injecting fillers?

At this point, he was able to see that this had levelled the area, without creating an undesirable outward curve, and he could now see the opportunity above to improve the lateral frontal fat pad, noting that when you correct one area, you see the transition more clearly elsewhere. Dr Tim likened this process to a ‘little bit of airbrushing’, changing the contour and harmonising the area by hiding the transition points between the temple, lateral forehead, and frontal eminence with a deep injection on the periosteum using a cannula (bevel facing downwards) and a fanning technique.

Using the same cannula entry point, Dr Tim also highlighted the technique for placing some dermal filler where the corrugator muscle inserts, which can present a mild shadow caused by frowning that does not resolve with botulinum toxin treatment.

Safe glabella filler injection techniques for Botox-resistant cases

Finally, he moved on to add a little volume to the glabella. This requires a different entry point because the cannula placement from before will not reach across. He chose to insert the cannula lateral to the glabella, avoiding the supraorbital vessels by going underneath them. He aspirated, compressed any vessels, and injected while moving, with placement at 90° to any vessels, making it far less likely for intravascular placement – watch the full video below to see the full techniques used.

Be sure to learn about potential complications with temple treatments like permanent neuropraxia and brow ptosis after cannula temple filler. If you have any tips to share, case studies to discuss, or questions about treating this area, you can also find Dr Tim Pearce on Instagram.

Anatomy360 - The Ultimate 3D Anatomy Course

Understanding facial anatomy is crucial for precise filler placement and achieving natural, balanced results. Knowledge of anatomical structures and vascular supply not only helps in avoiding complications but also enhances the overall effectiveness of treatments.

Dr Tim Pearce's anatomy course delivers a thorough understanding of facial anatomy through 12 online lessons. Tim says:

“The problem is we’re taught anatomy in 2D textbooks, but real-life anatomy isn’t flat. In order to feel confident with injecting and to get that millimetre by millimetre precision that increases safety, we need more detail. That’s why I’ve created the ultimate Anatomy learning experience specifically for aesthetic injectors. It’s going to help you up-level your anatomy knowledge and boost your injection safety & confidence in a way that no cadaver course could ever.”

Anatomy360 Course

Aesthetics Mastery Show

Mastering Temple and Frown Line Fillers: Safe Techniques for Resistant Cases

Dr Tim says:

“In this video, we tackle a complex upper face treatment focusing on the temples and forehead. You’ll learn how to blend previous treatments and address volume loss for a smooth, natural look. This patient had frown lines resistant to toxin and required a strategic approach to restore volume and enhance facial harmony.”

Watch the full Aesthetics Mastery Show here.

This episode has received many comments already including feedback from clients/patients as well as practitioners, including:

@erikachase9590

“She looks naturally refreshed. Beautiful work.”

@fakhrmoozarmi

“Are you on the bone when injecting the glabellar Lines? Thanks for your great educational videos.”

@Syrin23

“What is the ring you have to be able to aspirate?”

@xxjennifer1985xx

“@drtim I’m also going to ask about the metal ring you have attached to the syringe plunger. it looks like a really stabilising and comfortable way to aspirate. Did you have these made bespoke or can they be bought?”

@staffagirl

“Are you using a volumising product?”

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Dermal Filler eLearning Courses

If you want to increase your knowledge about safe and effective dermal filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• Dermal Fillers Foundation Course
• Dermal Filler Complications Mastery

Both give CPD and certificates on completion and are highly rated by our delegates.

In addition, browse our FREE downloadable resources on complications.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.