Hello everyone, welcome back to fact
facial assessment with clarius
technology. I'm Dr. Roy Zarm Zamin and
today episode is about the temple.
Temple is one of the most underrated
area in terms of aesthetic outcomes and
riskiest one of the riskiest area as
well because this area that has a lot of
vascularity and sometimes a variation in
vessel supply. It's very important to
know that's why treating this area most
of the time it should be multi-layering
and based on the ultrasound assessment
we decide what to do if we are going
multi-layering or one or two layer or
all three layers to treat. One of the
most popular treatment is superior steel
or gunshot technique which we are going
one of one over uh from the orbital rim
over the temporal crest to inject on the
bone. But it's crucial to do the safe
mapping with ultrasound to make sure
there is no vessel in that area before
place your product or damage the vessels
or emulate the vessels and the cause
going to be eskeeia or blindness.
Let's review the anatomy of the temple.
Temple starts from the temporal crest
which you can pulpate
or even you can scan which I'm showing
in a bit scanned with the scanner with
ultrasound to make sure where the
temporal crest is.
That's the temporal crest. I'm marking
down to orbital rim
and
this is superior border. Inferior border
is upper
side of zygomatic arch.
Anterior border is lateral part of the
orbital rim and then posterior is going
beyond the hairline. Now in terms of
injection and assessment
one area which is the swift point and
that's the suproperostial injection or
gunshot technique. It's 1 cm
upward on top of the crest and 1 cm just
vertical to the previous point. And this
is the area we usually go and do the
gunshot technique with ultrasound. I'm
showing you that we can scan this area
safe mapping this point if there is no
vessel on the perryioium that you can
inject. If there is a vessel close very
close to this point or
just underneath exactly in this point
underneath this point then either you
need to change the point or for this
case which has a little bit short temple
you need to think about or double think
and just choose another layer which is
interfacial or subcutaneous.
Now I'm going to scan the temple and
show you the layers
and safe mapping
for this area. I'm using Clarius L20
linear probe and then choose the
forehead temple preset.
Okay,
you see the temporal crest,
frontalis muscle, all the temporal
ligamentous adhesion and then you see
the bone in temporal fossa and then you
see temporalis muscle on top.
We're going to see the two lamina of
deep temporal fascia and the fat pad in
between. Above this is two lamina of
superficial temporal fascia and be
between these two fascia is interfasial
plane. Now we see some round shape and
echoic structure which is
the vessels
superficial vessels. I'm starting again
from the crest
just scanning downward
to check some of the vessels but these
vessels is not in my way of injection
even if I'm seeing it I know the depth
and everything if I'm going to use the
canula interfacial or superficial I be
careful to not hitting any vein pain or
arteries. Now I'm going to
map the injection point that we talked
about.
Place the midline marker of my probe on
my footprint
exactly on top of the injection point
which I marked.
And then turn on the midline marker
here.
Make sure I'm in the area
and turn on the color or power
and try to just a little bit movement
which I'm showing now
to see if there is any vessel or any
flow that I can see on top
which then you can realize if you don't
see any flow you can inject on the bone
then now I'm going to inject ultrasound
guided in interfasial plane and or maybe
subcutaneous if they need it you have to
be uh make sure that the area is clean I
disinfect the area if I'm going to
inject with a needle and needle might
touch the footprint of the scanner. I
cover the scanner uh with a sterile
cover or use the sterile gel. But if I'm
using the long canula and make sure
there is a little bit distance between
the injection point and the can and uh
just the scanner uh I don't need
anything you know like covering my uh
scanner
here. My entry point would be here on
top of the zygoma.
Just a little pinch.
If you approach from the zygoma,
it's very hard to go blind with naked
eye without ultrasound because if you go
on the bone on the perryostium of the
zygomatic arch and then go, you know,
just just introduce your canula toward
the temple, you are definitely going to
do the fat fat within two lamina of deep
not in the interfacial plane because
this fat fat is just running downward to
the
zygomatic area.
Introducing my canula
a little bit deep
going upward and check
with my scanner to make sure that I'm
in the right plane.
My scanner is here.
And
I'm checking
my needle which is here. You see my
needle has a very shiny bright
white
line. This is my needle and I'm going to
make sure that my needle is inter
fascial is in the interfacial plane.
here.
Let's just turn on the needle
enhancement
to see. Yeah, I'm inter internial
plane
and
going to inject. And you see this
reverberation in the bottom of the image
is the reverberation for needle.
And if you see the
dark
area is the HA filler that I'm injecting
in interfacial plane.
Okay. This is how you do the ultrasound
guided interfacial injection of
dermopillar into the temple. Now, if I'm
going to show you subcutaneous one
before I finish the treatment, I'm just
going to stop the scanning.
Usually for uh subcutaneous area, we're
not using uh the guide of the Sono.
For expert, they don't need to use it.
Interfacial is very hard to get into.
That's why we're using it. But I'm just
going to show you the different depth of
my canula
with ultrasound.
As you see my needle
here, very superficial
subcutaneous tissue as a white line,
hyper echcoic line here.
You see my needle and I'm just going to
inject a little bit to show you the
a little bit of
the injection.
That's my needle and injection. Okay,
this is how you treat the temple. Safe
mapping for supraperostial
ultrasound guided injection for
intrafasial or maybe use for
subcutaneous injection. Thank you for
joining us for this amazing episode
interesting episode because uh this is
very risky area and stay tuned for the
next one.