Hyaluronic Acid Filler Usage and Technique for the Facial Upper Third: A Comprehensive Review

Background: Facial aging entails complex alterations across various tissues, prompting individuals to seek aesthetic interventions. The anatomical complexities of the facial upper third and its proximity to vital vascular structures provide inherent risks. We aim to identify and elucidate the safety considerations and avenues for improvement regarding established injection sites and techniques for hyaluronic acid fillers in this area, encompassing the forehead and temporal region. Methods: We conducted a comprehensive literature search across PubMed, Embase, LILACS, and OpenGrey. Eligible studies were analyzed for injection sites, techniques, safety considerations, and anatomical landmarks. Qualitative synthesis and critical appraisal were used to identify trends, variations, and areas of consensus or controversy. Additionally, medical illustrations were created to deliver a practical overview. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute’s scoping review recommendations. Results: We included 7 studies in the review. Common injection sites included frontal and temporal regions, with variations in techniques noted across studies. Trends in filler placement and techniques were observed alongside several areas of controversy requiring further investigation. Conclusions: We underscore the absence of a standardized approach to hyaluronic acid filler injection sites and techniques for the facial upper third. Integrating anatomical knowledge with empirical evidence will be paramount in developing standardized techniques that prioritize patient safety and enhance treatment efficacy.