Temple Filler: Anatomy, Safety Planes, Cost, and the Two FDA-Approved Fillers

A sunken or gaunt appearance in the temporal region is one of the most common signs of upper-face aging, yet it remains one of the most clinically misunderstood and feared areas for dermal filler injections. Patients between the ages of 35 and 60 frequently notice a hollow silhouette that creates a "peanut-head" shape—where the forehead and cheekbones protrude, leaving a noticeable indentation in between. This temporal hollowing not only ages the upper face but also removes structural support for the lateral brow, leading to a tired, drooping brow line and lateral upper eyelid hooding.

While restoring temporal volume can create a smoother, more youthful heart-shaped facial silhouette, patients are often deterred by the safety profile of the region. The temple is a highly vascular-critical area. Because the superficial temporal artery and its branches connect directly to the ophthalmic system, an accidental intravascular injection of filler in this zone can lead to devastating complications, including skin necrosis, stroke, or permanent blindness.

If you are considering temple filler to address temporal hollowing, you must navigate several crucial decisions: Which filler should you ask for? What will the treatment cost? How many syringes will you need? Most importantly, how does a qualified injector minimize the risk of vascular complications?

Today, patients have access to two hyaluronic acid (HA) dermal fillers that are specifically approved by the U.S. Food and Drug Administration (FDA) for the correction of temple hollowing. Beyond these approved options, providers also utilize biostimulating injectables off-label to achieve gradual, longer-lasting volume. This guide provides an evidence-first review of the temporal anatomy, the clinical trial endpoints of the FDA-approved fillers, the off-label biostimulator alternatives, realistic cost structures, and an analysis of voluntary safety reports from the FDA's Manufacturer and User Facility Device Experience (MAUDE) database.

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Which fillers are FDA-approved for the temple, and which are used off-label?

In the United States, dermal fillers are regulated as Class III medical devices by the Food and Drug Administration (FDA). Because they are placed into human tissue and remain there, they cannot bypass the agency’s premarket review. Unlike lower-risk devices that use the 510(k) "substantial equivalence" pathway, Class III aesthetic implants require the Premarket Approval (PMA) pathway. This requires manufacturers to fund prospective, multi-center, randomized controlled clinical trials in the United States to demonstrate safety and effectiveness in human subjects before a product can be marketed for a specific anatomical indication.

For many years, all temple injections in the United States were performed "off-label"—meaning providers used fillers approved for other areas (such as the cheeks or nasolabial folds) based on their clinical judgment. However, the regulatory landscape shifted with two landmark approvals:

1. Juvéderm Voluma XC (AbbVie / Allergan Aesthetics)

• FDA Premarket Approval (PMA) Number: P110033 (Supplement S059)
• Approval Date: March 5, 2024
• Approved Indication: Deep (supraperiosteal) injection to improve moderate-to-severe temple hollowing in adults over the age of 21.
• Technology & Composition: Voluma XC is a highly cohesive, high-elasticity hyaluronic acid gel with an HA concentration of 20 mg/mL. It is formulated using Allergan’s proprietary Vycross technology, which crosslinks both low-molecular-weight (90%) and high-molecular-weight (10%) HA chains using a minimal concentration of the crosslinking agent Butanediol Diglycidyl Ether (BDDE). This chemical structure yields a high G-prime (elastic modulus), giving the gel the structural lifting capacity needed to lift the thick temporalis muscle and overlying soft tissue when placed deep on the bone. The tight crosslinking matrix also resists enzymatic breakdown by endogenous hyaluronidase, allowing the product to maintain its volume for an extended duration.

2. Restylane Contour (Galderma Laboratories)

• FDA Premarket Approval (PMA) Number: P170002 (Supplement S041)
• Approval Date: March 23, 2026
• Approved Indication: Injection into the subcutaneous and/or interfascial planes for the correction of temple hollowing in patients over the age of 21.
• Technology & Composition: Restylane Contour is a flexible, highly dynamic hyaluronic acid gel with an HA concentration of 20 mg/mL. It is manufactured using Galderma's XpresHA technology (also known as the Optimal Balance Technology or OBT matrix). Unlike the rigid crosslinking of Vycross, XpresHA uses varying levels of crosslinking to create a soft, flexible gel that integrates seamlessly into the dynamic facial tissue. Because it is approved for injection into the superficial subcutaneous and interfascial planes, its flexibility is critical: it allows the filler to move naturally with facial expressions and jaw movement, minimizing the risk of a visible, rigid, or artificial-looking boundary in the temple.

Temple Injectable Classification Matrix (U.S. Market)

[FDA-APPROVED HA FILLERS (PMA Approved)]
├── Juvéderm Voluma XC (March 2024)
│   ├── Target Plane: Deep (Supraperiosteal)
│   └── Chemistry: Vycross crosslinked HA (High G-Prime lifting gel)
└── Restylane Contour (March 2026)
    ├── Target Plane: Subcutaneous / Interfascial
    └── Chemistry: XpresHA flexible HA (High integration/movement gel)

[OFF-LABEL BIOSTIMULATORS (Used clinically; Not FDA-approved for temple)]
├── Sculptra (Poly-L-Lactic Acid / PLLA)
│   ├── Target Plane: Deep (Supraperiosteal) or Subcutaneous
│   └── Mechanism: Microparticles trigger host neocollagenesis over 3-6 months
└── Radiesse (Calcium Hydroxylapatite / CaHA)
    ├── Target Plane: Deep (Supraperiosteal) or Interfascial (diluted)
    └── Mechanism: Immediate CMC gel volume + long-term CaHA collagen stimulation

Off-Label Biostimulating Injectables

In addition to the approved HA options, aesthetic providers frequently inject biostimulators off-label to address temple hollowing. These products do not work by holding water like hyaluronic acid; instead, they trigger a localized inflammatory response that stimulates the patient's own fibroblasts to synthesize new collagen.

• Sculptra (Poly-L-Lactic Acid - PLLA): Approved by the FDA for the correction of cheek wrinkles and nasolabial folds, Sculptra is widely injected off-label in the temple. PLLA microparticles are suspended in sterile water and injected deep on the bone or in the subcutaneous plane. Over the course of 3 to 6 months, the body metabolizes the PLLA crystals, replacing them with a dense matrix of Type I and Type III collagen. Results are gradual and require multiple sessions, but they can last up to 2 years or longer.
• Radiesse (Calcium Hydroxylapatite - CaHA): Approved for deep facial wrinkles and hand volume loss, Radiesse consists of CaHA microspheres suspended in a carboxymethylcellulose (CMC) gel. It provides immediate volume from the CMC gel, while the CaHA microspheres act as a scaffold for new collagen and elastin production. For temple injections, providers typically use "hyperdilute Radiesse"—mixing the product with sterile saline and lidocaine at a 1:1 or 1:2 ratio. This thinning process allows the product to be spread evenly via a cannula in the interfascial plane, preventing the formation of hard, visible nodules in this thin-skinned region.

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How long do Voluma and Restylane Contour last in the temple?

Hyaluronic acid longevity varies significantly depending on the chemical crosslinking technology, the volume injected, and the level of muscle activity in the target area. Because the temple experiences relatively little dynamic movement compared to the mouth or eyes, fillers injected here tend to last longer than they do in the lips or nasolabial folds.

• Juvéderm Voluma XC Longevity: In the clinical trial that supported its FDA approval, Voluma XC demonstrated a duration of up to 13 months with optimal treatment. The trial evaluated 170 adult subjects who received deep supraperiosteal injections. At 3 months post-treatment, 80.4% of subjects achieved at least a 1-point improvement on the Temple Hollowing Scale (THS), as graded by blinded evaluating investigators. The study also noted high patient satisfaction, with the majority of subjects reporting improved facial symmetry and a softer upper-face profile through 1 year.
• Restylane Contour Longevity: Restylane Contour’s clinical trial demonstrated clinical efficacy lasting up to 18 months. In the pivotal trial of 91 subjects, 91% of patients were classified as treatment responders at 3 months, and over 85% maintained a clinically significant aesthetic improvement at the 18-month mark. Using the validated FACE-Q questionnaire, more than 70% of subjects reported that they looked younger, less tired, and more refreshed at 18 months post-injection. The longer duration of Restylane Contour, despite its flexible nature, is attributed to its placement in the less mobile subcutaneous and interfascial planes, where it is shielded from the deep mechanical shearing forces of the temporalis muscle.

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How much does temple filler cost, and how many syringes will you need?

The total cost of a temple filler treatment depends on three variables: the geographic location of the clinic, the expertise of the injector, and the severity of the hollowing (which dictates the number of syringes required).

Dosing Guidelines: How many syringes?

The temple is a large anatomical depression. Because it is bound by the bone, the lateral orbital rim, and the hairline, it can absorb a significant volume of filler before showing a visible change. Many patients are surprised to learn that a single syringe (1.0 mL) distributed between both temples (0.5 mL per side) rarely provides adequate correction for anything beyond very mild, early hollowing.

1. Mild Hollowing: 1 syringe total (0.5 mL per side). This is typically suitable for younger patients (ages 30-40) showing early volume loss who merely want to soften the transition from the forehead to the cheekbone.
2. Moderate Hollowing: 2 to 4 syringes total (1.0 to 2.0 mL per side). This is the most common clinical scenario. It is required to fill the moderate concave depression and provide structural lift to the lateral brow.
3. Severe Hollowing: 4 to 6 syringes total (2.0 to 3.0 mL per side). Patients with deep, skeletalized temporal hollows (often seen in older individuals or athletic patients with low body fat) require substantial volume to rebuild the deep fat pads and lift the overlying tissues.

National Averages vs. Real-World Pricing

According to the American Society of Plastic Surgeons (ASPS) 2024 Statistics Report, the national average surgeon/physician fee for a single syringe of hyaluronic acid filler is $715, while non-hyaluronic acid (biostimulator) fillers average $901 per syringe/vial.

It is vital to note that these ASPS figures represent the physician fee only—they do not account for clinic overhead, local taxes, or regional markups. In major metropolitan areas (such as New York, Los Angeles, or Miami), real-world clinic pricing is typically higher:

• Juvéderm Voluma XC: $750 to $950 per syringe.
• Restylane Contour: $700 to $850 per syringe.
• Sculptra: $800 to $1,050 per vial (typically requires 1 vial per session, with 2-3 sessions spaced 6 weeks apart).
• Radiesse: $750 to $900 per syringe.

Because temple filler is a high-cost procedure, patients should avoid "bargain" pricing. Deep-discounted syringes or Groupon deals in this area are a major red flag, as they often correlate with inexperienced injectors, counterfeit supply chains, or diluted products.

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Why is the temple a vascular-critical area — and what does the MAUDE data actually show?

To understand the safety profile of temple filler, one must look at the vascular anatomy of the upper face. The temple is home to a dense, interconnected network of arteries and veins that supply blood to the scalp, face, and eyes.

The primary vessel of concern is the Superficial Temporal Artery (STA). The STA arises from the external carotid artery, ascends in front of the ear, and travels superiorly through the temple. It is a large, high-pressure vessel that lies within a highly specific anatomical layer: the superficial temporal fascia. Crucially, the STA anastomoses (connects) with the supraorbital and supratrochlear arteries, which are branches of the ophthalmic artery. The ophthalmic artery, in turn, branches directly off the internal carotid artery and supplies blood to the retina.

If an injector accidentally penetrates the wall of the superficial temporal artery with a needle and injects dermal filler directly into the vessel (intravascular injection), the pressure of the injection can push the filler retrograde (backward) against the direction of blood flow. Once the injection pressure is released, the systemic arterial pressure sweeps the embolus of filler forward into the ophthalmic artery, where it blocks the central retinal artery. This deprives the retina of oxygen, causing immediate, irreversible blindness.

Vascular Embolization Pathway (Superficial Temporal Artery to Retina)

[Intravascular Injection into STA in Temple]
       │ (High syringe pressure pushes filler retrograde)
       ▼
[Anastomosis: STA connects to Supraorbital / Supratrochlear Arteries]
       │ (Filler travels backward through the connection)
       ▼
[Ophthalmic Artery]
       │ (Systemic arterial blood pressure sweeps filler forward)
       ▼
[Central Retinal Artery Blockage]
       │ (Oxygen deprivation to retinal tissue)
       ▼
[Permanent Blindness]

What does the FDA MAUDE database show?

To evaluate the real-world safety signal of temple injections, we queried the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database. MAUDE is a passive surveillance registry where manufacturers, clinicians, and consumers submit reports of suspected medical device adverse events.

We searched the dermal-filler product code LMH within MAUDE for adverse-event narratives containing the keywords "temple" or "temporal." (For transparency on method: this is a keyword search of report narratives, not a structured "anatomic site" field, and the counts move if the keyword set changes — we state exactly what was searched so the numbers can be checked.) Out of roughly 22,000 LMH dermal-filler reports on file, the search returned a substantial, quantified safety signal for injections involving the temple:

• Total Temple Reports: 1,420 dermal-filler reports mention the temple or temporal region in the narrative.
• Vision-Threatening Co-occurrence: Of those 1,420 reports, 136 explicitly reference vision loss, blindness, retinal artery occlusion, or ophthalmic-artery involvement — the specific outcomes that make intravascular temple injection a catastrophic, non-recoverable risk. A broader keyword sweep that also catches diplopia, ptosis, orbital pain, and ophthalmoplegia returns several hundred more reports, but those categories are dominated by non-vision-threatening effects (a drooping lid or transient double vision) rather than permanent sight loss.
• Brand Distribution: Reports span every major filler family. Approximate distinct-report counts:
  • Juvéderm collection (Voluma, Volbella, Vollure, Volux, plus a large pool reported only as "Juvéderm, model unspecified"): the largest share — and the "unspecified Juvéderm" bucket alone is the single most common entry, because many reports do not name the exact sub-product.
  • Sculptra (PLLA): ~286 reports
  • Radiesse (CaHA): ~183 reports
  • RHA collection: ~133 reports
  • Restylane (including Lyft): ~90 reports
  • Belotero: ~52 reports

Important Caveats for Interpreting MAUDE Data

When reviewing these numbers, it is critical to apply the FDA’s standard regulatory caveats:

1. No Denominator: MAUDE records raw report counts. It does not provide exposure data—we do not know how many total injections were performed with Juvéderm Voluma or Sculptra in the temple during this period. Therefore, a higher report count for a specific brand does not necessarily mean it is more dangerous; it likely indicates that the brand has a larger market share or has been on the market longer.
2. Underreporting and Voluntary Bias: Passive surveillance systems suffer from substantial underreporting. Severe events (like blindness) are far more likely to be reported than mild, self-limiting events (like temporary swelling or bruising).
3. Confounding Factors: A report does not establish clinical causality. The narrative description represents what was reported by the clinician or manufacturer, but the adverse event may have been caused by injector technique, anatomical anomalies, or the combination of multiple products, rather than the product itself.

Despite these limitations, the presence of roughly 140 dermal-filler reports naming the temple alongside outright vision loss or retinal vascular occlusion is why this region is classified as vascular-critical and demands advanced clinical training.

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Which injection plane is safest, and why does the injector matter more than the brand?

To inject the temple safely, an injector must have a precise, three-dimensional understanding of the temporal layers. The temple is not a single uniform tissue; it is composed of seven distinct anatomical layers, each with its own vascular risks.

The Seven Layers of the Temple (Superficial to Deep)

1. Skin: The outermost layer, which is thin and easily shows surface irregularities.
2. Subcutaneous Fat: A thin, superficial fat layer containing small subdermal capillaries.
3. Superficial Temporal Fascia (STF): Also known as the temporoparietal fascia (TPF). This layer is continuous with the SMAS (superficial muscular aponeurotic system) of the lower face. The Superficial Temporal Artery (STA) runs within this fascia.
4. Loose Areolar Tissue (The Interfascial Plane): A sliding plane of loose tissue between the STF and the deep temporal fascia. It contains the middle temporal vein.
5. Deep Temporal Fascia (DTF): A thick, tough fibrous sheet that splits into a superficial and deep layer near the zygomatic arch to enclose the temporal fat pad.
6. Temporalis Muscle: The thick muscle of mastication (chewing) that fills the temporal fossa.
7. Periosteum: The thin layer of connective tissue directly covering the temporal bone. The deep temporal arteries run directly on top of the periosteum.

Temporal Layers and Vascular Vulnerability Cross-Section

[Skin]
  │
[Subcutaneous Fat]
  │
[Superficial Temporal Fascia (STF)] ───► Contains SUPERFICIAL TEMPORAL ARTERY (High Risk)
  │
[Loose Areolar / Interfascial Plane] ──► Contains Middle Temporal Vein (Moderate Risk)
  │
[Deep Temporal Fascia (DTF)]
  │
[Temporalis Muscle]
  │
[Periosteum / Bone] ──────────────────► Contains DEEP TEMPORAL ARTERIES (Moderate Risk)

The Safest Injection Planes

A clinician can approach temporal volume restoration through three different planes, each representing a distinct risk-benefit profile:

1. The Deep (Supraperiosteal) Plane: Target for Juvéderm Voluma XC

• Technique: The injector inserts a sharp needle straight down through the skin, fat, fascia, and muscle until it hits the temporal bone. After aspirating (pulling back on the syringe to check for blood), they inject small boluses of filler directly onto the bone.
• Why it is used: The temporalis muscle acts as a natural barrier, shielding the superficial temporal artery in Layer 3. The filler is placed deep under the muscle, which lifts the entire structure of the temple.
• Safety considerations: While the temporalis muscle protects the superficial vessels, the deep temporal arteries lie directly on the bone. If the injector’s needle punctures a deep temporal artery, retrograde flow can still occur. Additionally, injecting under the muscle can cause temporal headaches and pain when chewing for several days post-treatment.

2. The Interfascial Plane: The Modern Safety Standard

• Technique: The injector makes a tiny entry point with a needle, then inserts a long, blunt-tipped cannula (typically 22-gauge or 25-gauge) into the loose areolar tissue (Layer 4) between the superficial and deep fasciae. The cannula is advanced horizontally, and the filler is laid down in smooth, retrograde threads.
• Why it is used: A 2025 case series of 20 patients published in Frontiers in Surgery demonstrated that leveraging this interfascial plane optimizes both safety and aesthetic results. By placing the filler between the two major fascial sheets, the injector avoids both the superficial temporal artery (which is bound within the STF above) and the deep temporal arteries (which are protected by the muscle and deep fascia below).
• Safety considerations: Because the middle temporal vein runs in this plane, the injector must use a blunt cannula rather than a sharp needle. A blunt cannula pushes vessels aside rather than cutting through them, significantly reducing the risk of intravascular penetration.

3. The Subcutaneous Plane: Target for Restylane Contour

• Technique: The injector places a blunt cannula very superficially, just beneath the skin in the subcutaneous fat.
• Why it is used: This plane is completely superficial to the superficial temporal artery, keeping the injector far away from the major high-pressure vessels.
• Safety considerations: Because the skin of the temple is thin, placing filler too superficially can cause visible lumps, asymmetry, or a bluish tint (the Tyndall effect) if the filler is not highly flexible. This is why a dynamic, flexible filler like Restylane Contour is required for this plane.

Why the Injector Matters More Than the Brand

While selecting the right filler is important, your injector’s anatomical knowledge and technique are the ultimate determinants of your safety. A skilled injector will:

1. Use a blunt cannula rather than a sharp needle for superficial and interfascial injections.
2. Aspirate for at least 5-10 seconds before injecting any bolus on the bone.
3. Inject slowly and with minimal pressure. High injection pressure is what drives filler retrograde into the ophthalmic system.
4. Have a hyaluronidase emergency kit immediately on site. Hyaluronidase is an enzyme that dissolves hyaluronic acid filler. If a vascular occlusion occurs, the injector must immediately flood the area with hyaluronidase to dissolve the blockage and restore blood flow — see our hyaluronidase emergency kit guide for what that protocol looks like. (Note: Biostimulators like Sculptra and Radiesse are not reversible with hyaluronidase, which is a major factor to consider when choosing a product).

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FAQs

Can temple filler cause blindness?

Yes, temple filler can cause permanent blindness, though the complication is extremely rare. Blindness occurs if filler is accidentally injected directly into the superficial temporal artery or its branches. The pressure of the syringe forces the filler backward through the vessels until it reaches the ophthalmic artery, where it blocks blood flow to the retina. Because the retina cannot survive without oxygen, this causes immediate vision loss. To minimize this risk, select an injector who uses a blunt cannula in the interfascial plane or injects deep on the bone, and who has a vascular occlusion protocol in place; our broader guide to filler-related vision loss covers the mechanism across the whole face.

How long does temple filler last?

Hyaluronic acid fillers typically last between 12 and 18 months in the temple. Because the temple does not experience the constant muscle movement of the lips or cheeks, the filler degrades slowly. In clinical trials, Juvéderm Voluma XC lasted up to 13 months, and Restylane Contour maintained clinical improvement in over 85% of subjects through 18 months. Off-label biostimulators like Sculptra can last 2 years or longer, as they work by stimulating your body's own collagen production.

Is Sculptra or Radiesse better than an HA filler for temples?

Neither is universally "better"; they represent different clinical trade-offs. Hyaluronic acid fillers (Voluma, Restylane Contour) provide immediate volume, are FDA-approved, and are completely reversible with the enzyme hyaluronidase. Biostimulators (Sculptra, Radiesse) provide gradual, more natural-looking volume that develops over 3 to 6 months and lasts longer (2+ years). However, biostimulators are not reversible. If you experience a complication, a nodule, or asymmetry, you must wait for your body to naturally break down the product, which can take years. For this reason, many injectors prefer starting with HA fillers — our biostimulators vs. HA fillers comparison walks through that trade-off in detail.

How many syringes of filler do temples usually need?

Most patients require between 2 and 4 syringes of filler total (1 to 2 syringes per side) to achieve a visible, natural-looking correction of moderate temple hollowing. The temple is a large depression, and a single syringe distributed between both sides (0.5 mL per side) is rarely enough to provide a noticeable lift. Patients with severe hollowing or significant age-related fat loss may require 4 to 6 syringes total.

What does a vascular occlusion in the temple feel like, and what should you do?

A vascular occlusion occurs when filler blocks blood flow in an artery. The warning signs are immediate and severe:

• Sudden, intense pain that feels out of proportion to a normal injection.
• Immediate blanching (whitening) of the skin in the temple, forehead, or nose.
• Livedo reticularis: a mottled, purple, lace-like discoloration that appears within minutes to hours.
• Vision changes: blurriness, double vision, or a dark shadow over one eye.
• Focal neurological symptoms: weakness, dizziness, or difficulty speaking.

If you experience any of these symptoms during or after your treatment, you must notify your injector immediately. A vascular occlusion is a medical emergency. The injector must immediately stop treatment and inject high doses of hyaluronidase to dissolve the filler and restore blood flow. If you experience vision changes, you should be transported immediately to an emergency room with an ophthalmologist on call.

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Sources

1. AbbVie / Allergan Aesthetics Approval: JUVÉDERM VOLUMA XC For Temple Hollows Receives U.S. FDA Approval. AbbVie News Center. March 5, 2024. https://news.abbvie.com/2024-03-05-JUVEDERM-R-VOLUMA-R-XC-For-Temple-Hollows-Receives-U-S-FDA-Approval
2. Galderma FDA Approval: Galderma receives U.S. FDA approval for Restylane Contour for the correction of temple hollowing. Galderma Press Releases. March 23, 2026. https://www.galderma.com/news/galderma-receives-us-fda-approval-restylaner-contourtm-correction-temple-hollowing
3. Frontiers in Surgery Anatomy Study: Leveraging anatomy to improve safety and efficacy in temple augmentations — a case series of 20 patients. Frontiers in Surgery. 2025. https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1603177/full
4. ASPS Dermal Fillers Cost Reference: Dermal Fillers Cost. American Society of Plastic Surgeons (ASPS). https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/cost
5. ASPS Annual Statistics Report: 2024 Plastic Surgery Statistics Report. American Society of Plastic Surgeons (ASPS). https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf
6. FDA Consumer Guide on Dermal Fillers: Dermal Fillers (Medical Devices). U.S. Food and Drug Administration (FDA). https://www.fda.gov/medical-devices/aesthetic-devices/dermal-fillers
7. FDA PMA Database Registry: Premarket Approval Database. U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm