Q: Dr. Eppley, I would like to have temporal augmentation on both sides. I want a permanent solution which means no fat injections. I don’t want to have to do it every few years. I am ok with silicone implants. Because there are nerves in temporal area is temporal augmentation safe? I am scared of getting my nerves hurt. Can you please tell me what are the possible options for the implants.
A: The use of preformed synthetic implants is the only assured method of permanent temporal augmentation. There are several different designs from two manufacturers today. These implants are most commonly placed below the temporalis fascia on top of the muscle. The frontal branch of the facial nerve which runs through the temporal area lies above the deep temporal fascia, thus subfascial temporal implant placement poses no danger to this nerve which is responsible for movement of the forehead and eyebrow. There are some cases in severe temporal hollowing with a tight fascial lining in which the implants are better placed above the fascia to get the desired augmentation effect. This is usually necessary when there is a large step-off between the zygomatic arch and the temples. When above the fascia, it is important to place it right up against the deep fascia and avoid dissection in the more superficial fascial layers where the nerve runs. When done properly, temporal implants placed above the fascia are safe.
Dr. Barry Eppley