Are Restylane injections or fat grafting injections better for filling temporal hollows?

Dr. Dean Kane Q & A Q. I have very hollow temples (after a craniotomy to remove a benign tumor) and want to know if corrections with an injection of Restylane has major complication risks concerning vascular occlusions that is less risky than longer lasting fat injections? A. ​ ​I hope you are well following your craniotomy! ​ ​Fillers injections are the way to go for temporal hollowing. As you have inquired, Restylane and Fat are 2 of several fillers I use for this problem. Each comes with its advantages and disadvantages. ​ ​Fat is a wonderful biologic replacement for atrophic areas to be filled. It must revascularize in order to survive but the temples provide a very good environment for this to occur. That said, anticipate 50-70% of the fat injected may resorb. Due to the small volumes you will need on several sessions, this may be done under local anesthesia with or without oral or IV sedation. ​ ​Injectable fillers include temporary and more permanent, inert or bio-stimulatory molecules. ​Restylane is part of a family of temporary fillers called Hyaluronic Acid (HA) gels. Each HA is created with the same molecule but of different lengths and with more or less links. These attributes add to longevity and hydrophilia (water attraction) and projection. ​ ​Another filler I might recommend to consider with the evaluation of a talented and skilled, Board Certified Plastic Surgeon or ENT Facial Surgeon is Sculptra. This not so well known bio-stimulatory filler may be used alone or with HA’s. Sculptra initiates the body’s own response to firm and fill with structural molecules such as hyaluronic acid, elastin and others. It works very well in the temporal hollows but there is a 3 month lag period and the need for multiple sessions. ​ ​All fillers including fat have the concern of intravascular injection and vessel occlusion. This is a risk to discuss with your injector(s). ​ ​Depending on the amount of hollowing or deformity, implant surgery may be available as well. ​ ​I hope this has been helpful! I wish you the best!
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