Temple Hollowing and Midface Volume Loss: What PDRN Can and Cannot Restore

📅 May 2, 2026 👤 Restorative and Medical Skincare Researcher Simon Finch ⏱ 14 min read

Temple Hollowing and Midface Volume Loss: What PDRN Can and Cannot Restore

You look in the mirror and your face looks... smaller. The upper cheeks have flattened. There's a concavity at your temples that makes your brow bone look more prominent. Your eyes look deeper set, almost sunken. You haven't lost weight, but your face looks thinner, harder, less soft. You wonder if this is what people mean when they say someone has "lost their face."

Temple hollowing and midface volume loss are the most impactful volumetric changes in facial aging. They change the entire geometry of the face — the proportions, the contours, the light and shadow. And they are the changes that topical skincare cannot touch. No cream, no serum, no amount of moisturizer will fill a hollow temple or restore a flattened cheek.

What Temple Hollowing Actually Is

Temple hollowing — the concavity that develops on the side of the forehead above the zygomatic arch — is often misunderstood as skin aging. It is not.

The Layers of the Temple

The temple is composed of, from deepest to most superficial:

1. Temporal bone: The bony foundation of the temple region.
2. Temporalis muscle: A large, fan-shaped muscle that moves the jaw. This muscle atrophies with age — losing mass and thickness — and this atrophy is the primary cause of temple hollowing.¹
3. Deep temporal fat pad: Located between the temporalis muscle and the superficial fascia. This fat pad also atrophies with age, contributing to the concavity.
4. Superficial temporal fascia (temporoparietal fascia): A thin connective tissue layer.
5. Subcutaneous tissue: Minimal — there is very little fat between the fascia and the skin in the temple area.
6. Skin: The temple skin is among the thinnest on the body — 0.3–0.5 mm — with virtually no subcutaneous fat beneath it.

When you see a hollowed temple, you're primarily seeing the space left by a shrunken temporalis muscle and an atrophied deep fat pad. The skin itself has changed very little — it's simply collapsing into the space that used to be filled.

Midface Volume Loss: A Multi-Layer Problem

Midface volume loss — the flattening of the cheek, the deepening of the nasolabial fold, the tear trough hollow — is caused by changes at every layer:

Bone Resorption

The maxilla (the bone that forms the cheek prominence) resorbs with age. The pyriform aperture (the bone around the nose) widens. The orbital rim (the bone around the eye) expands. These skeletal changes reduce the structural support for the overlying soft tissues, allowing them to descend and creating the appearance of volume loss.²

Fat Compartment Atrophy and Descent

The midface contains several named fat compartments. The malar fat pad — the "cheek apple" — does two things with age: it descends downward, and it loses volume through adipocyte atrophy. The deep medial cheek fat pad (medial sub-orbicularis oculi fat) also atrophies, contributing to tear trough hollowing and the "dark circle" appearance under the eyes.

Ligament Weakening

The retaining ligaments of the midface — the zygomatic ligament, the orbitozygomatic ligament, the masseteric ligament — stretch and weaken with age. These ligaments are supposed to hold the fat compartments in place. When they fail, the fat descends, and the volume appears to be "lost" when it's actually just relocated downward.

Skin Thinning Over the Checkbone

Over the malar eminence (the cheekbone), the skin is naturally thin. With age and collagen loss, it becomes even thinner, providing less coverage over the bone. This contributes to the "skeletonized" appearance of the midface.

Where PDRN Actually Helps

Given the above — that temple hollowing and midface volume loss are primarily caused by changes in bone, muscle, and fat — you might wonder if PDRN has any role at all. It does, but the role is specific and limited.

1. Dermal Thickening Over the Cheekbone

The skin over the malar eminence becomes progressively thin and transparent with age. PDRN stimulates fibroblast activity in this area, increasing dermal collagen content and thickness by 15–20% over a course of treatment.³ Thicker skin provides better coverage over the cheekbone, reducing the skeletonized appearance and creating a softer contour.

2. Improving the Skin "Drape" Over the Temple

While PDRN cannot restore the atrophied temporalis muscle or temporal fat pad, it can improve the quality of the skin that covers the temple concavity. Healthier, thicker, more hydrated temple skin reflects light better and creates a smoother appearance over the hollowed area.⁴

3. Supporting the Post-Treatment Recovery

Where PDRN truly shines in this context is as an adjunctive treatment. When temple hollowing is corrected with filler or fat transfer — and midface volume loss is addressed with filler, Sculptra, or fat — PDRN prepares the tissue to receive these treatments and supports the healing process afterward. Pre-treatment with PDRN (2–3 sessions) creates healthier tissue for filler placement, potentially improving filler longevity and reducing the risk of irregularities.⁵

4. Preventing Skin Quality Deterioration

PDRN's most valuable role for temple and midface aging may be prevention. Maintaining dermal thickness, elastin function, and collagen quality through regular PDRN maintenance (every 4–6 months) can slow the rate at which the skin itself contributes to the appearance of volume loss. The bone and fat changes will continue, but you'll be preserving the best possible skin environment over those deeper changes.

What PDRN Absolutely Cannot Do

For the temples and midface, the limitations are sharp and clear:

• Cannot fill the temple hollow: The concavity in the temple is primarily an empty space left by muscle atrophy and fat loss. PDRN does not add volume. Filling requires hyaluronic acid filler, calcium hydroxylapatite, Sculptra, or autologous fat transfer.
• Cannot restore midface volume: The flattened cheek cannot be plumped by PDRN. Volume restoration requires filler (placed deep, on the bone or in the deep fat compartments), Sculptra (for gradual collagen replacement), or fat transfer.
• Cannot lift a descended malar fat pad: The cheek apple that has dropped toward the nasolabial fold requires mechanical lifting — either through thread lifts, energy-based devices, or facelift surgery.
• Cannot improve the tear trough: The hollow under the eyes that creates dark circles and a tired appearance is caused by periorbital fat atrophy and ligament laxity. PDRN cannot fill this depression.

An Honest Comparison: PDRN vs. Volume Restoration

The Bottom Line

Temple hollowing and midface volume loss are structural problems. They involve the bone, the muscle, the fat, and the retaining ligaments — all layers that PDRN cannot reach or restore. No amount of PDRN will fill a hollow temple or restore a flattened cheek.

But the skin layer matters too — and this is where PDRN contributes. Thicker, healthier, more resilient skin over the midface and temples softens the visual impact of volume loss, creates better light reflection, and provides a better canvas for volume restoration treatments. As prevention, PDRN maintains the skin quality that will inevitably thin with age.

If your primary concern is temple hollowing and midface volume loss, the honest answer is: you need volume replacement (filler, Sculptra, or fat). PDRN should be your support act, not your main event. But when combined in the right sequence, the two approaches produce results that neither can achieve alone.