hi it's Dr John Arlette in Calgary Alberta Canada in this section we're going to talk about visualizing the temple and Temple is an important structure for us to be working on uh to fill with filler and it's important structure because it has so many layers and depending on how you choose to inject it's important to know what is beneath your cannula or your needle whether you're over vessels which fascia you're going through as well as how deep it is and the muscle so let's take a close look at the temple really going from the posterior aspect to the anterior aspect first of all we'll scan with the B mode looking at brightness and then we'll come back looking for vessels so we've got lots of gel on our device we're going to orient it remember our little orientation device is at the top because it's vertical we're going to come into the temple we're going to make our depth 2.8 centimeters because the temple is really the deepest part of the face where we're going to be able to see what's underneath so I'm just going to scan forward and give us an idea as you practice you will find that this starts to become three-dimensional movie in your mind you'll begin to place that into a three-dimensional view of what's beneath your device so here we are in the posterior aspect we can see the temporalis muscle deep to the tissue we can see fascia at the top we can move forward we can see changes in the thickness of the fat layer and of the temporalis muscle so when we're thinking where we're going to put our injection we're going to go superiorly along the suture and we can see how this starts to become superficial how it becomes more shallow by making sure you have an adequate gel pad you can see the gel pad at the top of the screen if you press you make that disappear so you want to be able to see your gel pad to know that you're seeing the actual representation of the tissue below you all on the basis of the amount of tissue that's normally there without it being compressed since you can see that happen and so also when you're injecting it helps you to know that if you're pressing with your hand you're going to change your location as well as how you move your needle or cannula forward or backward vascularity in the temple is extensive you have a tremendous arcade of veins particularly The Sentinel vein here at the medial aspect and you'll find that coursing throughout the temple so there's lots of veins and we'll just press on this and they'll go away now we also want to be looking for the superficial temporal artery because we'd like to avoid that while we're working and there's the superficial temporal artery It's relatively small in this circumstance you can see how everything else clears away with a little bit of compression and there's our artery back again and these again are tortuous within the tissue we can see how our fibrous structures separate as we go down deeper into the temple as you'll be looking for different locations that you'll want to be injecting into a very specific technique for enhancing facial features when we're looking at the temple there's a number of layers and whether we talk about it being 10 7 or 8. think about how we're going to put our cannula or our needle selectively into one of those locations and for those who inject the temple this will be a great asset to just confirm your placement both during treatment and and after treatment so we'll just move up a little bit one of the areas where we see frequent injections is here about a centimeter above the lateral aspect of the temple a centimeter down from the suture line so a very easy place for us to work on this section we've talked about the temple a complex anatomical structure it's important to go through the area slowly scanning both vertically as well as laterally horizontally in order to get a good appreciation of all the structures that are present and then the interrelationship with the vascular structures that lie below the skin thank you very much foreign
