Complementary Strategies for Temporal Lifting Techniques: Biomechanical Insights From Combined Injection Techniques.

BACKGROUND: Although the use of hyaluronic acid-based soft tissue fillers in the lateral facial region is known to have full-face aesthetic effects, systematic comparisons of injection techniques remain limited. AIMS: To compare the full-face effects of posterotemporal lifting alone and combined with supraperiosteal zygomatic arch injection, and to evaluate the use of images from three device types for aesthetic assessment. METHODS: Data from 20 female Asian patients (group A, 38.0 ± 6.29 years; group B, 41.5 ± 6.72 years) was analyzed retrospectively. Group A received single-point subcutaneous posterosuperior temporal injections, and group B additionally received supraperiosteal zygomatic arch injections. Outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and three-dimensional (3D) quantifications of volume and vector changes in the medial (maxillary and medial mandibular regions) and lateral [temporal region (superolateral face) and lateral mandibular region (inferolateral face)] face. GAIS ratings of images obtained with three device types were compared. RESULTS: Mean local (superolateral, inferolateral, and medial face) surface volume changes were 0.46 ± 0.36, 1.16 ± 1.03, and 0.03 ± 0.55 cubic centimeter (cm3), respectively, in group A, and 0.23 ± 0.38, -0.76 ± 0.96, and -0.37 ± 0.60 cm3, respectively, in group B. More vector displacement in the inferolateral and medial face was generally observed in group B. GAIS scores favored group B over group A, and 3D imaging over two-dimensional imaging. CONCLUSION: Combined temporal lifting with supraperiosteal zygomatic arch injection may achieve better facial lifting effects than simple temporal lifting performed with the same filler volume.