Q: Dr. Eppley, However, is it really not possible to reduce the temporo-occipital region of the skull through some bone reduction and some reduction in the temporalis muscle in order to maintain proportionality if a reduction malarplasty is done? Something of the order of 6 to 7mm either side would still be very significant to me. I realize that there are limits to what can be done due to outer cortical table thickness. Would a CT scan be useful in determining feasibility or do you feel that nothing can simply be done?
A: The most limiting area of the skull to reduce, because it is the thinnest is the temporal/temporo-occipital region. I know that without even seeing any formal radiographic studies by experience. More significant reduction can be achieved by temporalis muscle reduction/thinning. This is more effective because the muscle is so thick, particularly near the forehead and lateral orbital rim. In essence, it is located closer to the face thus creating a greater effect. I could envision a temporalis muscle reduction combined with zygomatic narrowing as being a viable procedure.
Dr. Barry Eppley