The temples are the anatomical areas located on the side of the head, situated laterally to the eyes and forehead, just before the hairline and above the cheekbones. This region is a complex junction where four skull bones—the frontal, parietal, temporal, and sphenoid—converge. “Sunken temples,” or temporal atrophy, describes a concavity or hollowed appearance caused by volume deflation in the underlying soft tissues and bone structure. This change is a common aesthetic concern because it can make the face appear gaunt or aged, and may signal an underlying health issue.
How Natural Aging Causes Volume Loss
The gradual hollowing of the temples is primarily a consequence of chronological changes affecting the layered architecture of the face. Over time, the deep and superficial fat pads that provide a smooth, full contour to the temporal region begin to diminish through atrophy. This volume deflation causes the overlying skin to lose its structural support, leading to concavity.
The supportive skeletal framework also undergoes significant remodeling as part of the aging process. The underlying temporal bone structure slightly recedes, which further contributes to the loss of projection in the upper face. This recession removes a foundational support layer for the overlying soft tissues, exacerbating the appearance of hollowing.
The outermost layer, the skin, also becomes thinner and less resilient with age. A progressive decline in the production of collagen and elastin reduces the skin’s structural integrity and elasticity. This loss of dermal thickness cannot mask the diminishing volume in the deeper layers, making the temporal concavity more pronounced and emphasizing the bony contours beneath the surface.
Systemic Health and Lifestyle Triggers
While natural aging is a slow process, certain systemic conditions and lifestyle factors can accelerate temporal hollowing or cause it to appear rapidly. A sudden reduction in body mass, such as through rapid weight loss, often results in visible facial volume loss. The body does not regulate where fat is lost, and the face, especially the temples, is a common site for early fat depletion.
Severe dehydration can also cause temporary volume loss that accentuates the hollowness in the temples. When the body lacks sufficient fluid, the tissues, including those in the face, can appear deflated until proper fluid balance is restored. This effect contributes to a similar sunken appearance.
In cases of chronic illness, cachexia, or wasting syndrome, leads to profound muscle and fat loss throughout the body. Diseases like advanced cancer, chronic obstructive pulmonary disease, or heart failure cause a systemic breakdown of lean body mass, which is often visible in the temples. This wasting is driven by an imbalance in metabolism and chronic inflammation that prioritizes the consumption of the body’s own tissues for energy.
Specific medical treatments can also trigger targeted facial fat loss. For instance, some older antiretroviral medications used to manage HIV infection were associated with lipodystrophy, causing selective wasting of facial fat, including in the temporal area. When temporal hollowing is acute or linked to a change in health, the underlying systemic cause must be addressed.
Clinical Options for Restoration
Addressing the appearance of sunken temples begins with stabilizing any underlying health issues contributing to volume loss, such as malnutrition or rapid weight changes. Once the patient is medically stable, various clinical interventions are available to restore a smoother, more youthful contour.
The most common and least invasive solution is the use of injectable dermal fillers, typically those made with hyaluronic acid. This gel-like substance is carefully injected deep into the temple to replenish lost volume and re-establish a continuous contour between the forehead and cheek. Hyaluronic acid fillers provide immediate results, but the effects are temporary, generally lasting several months up to a year before the product is metabolized by the body.
For a more permanent correction, autologous fat transfer, or fat grafting, is a surgical option. This procedure involves harvesting a small amount of the patient’s own fat from a different area of the body using liposuction. The fat is then purified and strategically injected into the temples to restore volume, offering a natural and long-lasting solution since the transferred fat cells can establish a new blood supply and survive permanently.
Other options include biostimulatory fillers, which encourage the body to produce its own collagen in the treated area over time. These treatments offer a more gradual and sustained improvement in volume and skin quality. Regardless of the method chosen, the procedure requires a practitioner with advanced knowledge of the temporal region’s complex anatomy to ensure safety and an aesthetically harmonious outcome.