Q: Dr. Eppley, I am inquiring about temporal muscle reduction surgery. My husband’s temporalis is very prominent when he chews and I was wondering if this is something to be worried about. He’s a healthy 25 year old and has no symptoms. Can this be fixed?
A: Having prominent, large or hyperactive temporalis muscles is not something to be worried about for any medical reason… unless one is having chronic muscle pain or spasm from their large size. Many men in particular have prominent temporalis muscles which can become very prominent in its convexity on the side of the head. The larger the lower jaw, the bigger the muscle has to be to open and close it. Thus, the bigger the muscle the more prominent it will be seen when in use from chewing when it maximally contracts.
Whether one should reduce the size of the muscle ‘(fix it’) by temporal muscle reduction surgery is an aesthetic concern not one of medical necessity. Some of the most prominent portions of the temporalis muscle can be reduced/thinned to reduce its bulging appearance (make the area above the ears flatter and not convex) without any effects on jaw opening and closing in my experience with this type of surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I am a young man and I am embarrassed of the shape of my head. My head circumference is about 58 cm which seems to be only about 1-2 cm more than the average but the shape is abnormal- as it gets wider above the ears and temples on both sides. What is very surprising when I clench my jaw both sides of the head gets wider (about 0.5 cm) each side, and when I widely open my mouth both sides of the head get thinner and head looks almost normal. Would you be so kind to answer my questions. Is there any possibility to reshape my head on both sides. If yes what is the potential risk of such surgery- is there any chance to damage my brain, nerves, veins etc and is such surgery a big risk for my health and life? Does the surgery may affect in a bad way circulation of the blood in my head which my cause for example hair loss (it is extremely important for me to protect my hair because that is the only way I can mask shape of the head). What is the recovery time? I train bodybuilding and boxing especially the second one is obviously extremely contact sport- will I be able to continue my two passions and how long after surgery will I be able to come back to training?
A: What you are describing perfectly are thick temporalis muscles which is making a major contribution to the width that you are seeing above your ears and into the temple region. This is evidenced by the widening effect that occurs when you clench your teeth together (temporalis bulging) and why it gets thinner when you open your mouth. (stretches and thins the temporalis muscle) This dynamic head width changes indicate that a temporal reduction (temporalis muscle shortening/relocation procedure) would be very effective. This results in a 5 to 7mm change per side (1.0 to 1.5 cms transversely combined) when these muscles are shortened. In addition a small amount of bone burring can be done at the same time. Not that you know the correct procedure, the answer to your questions are as follows:
1) There is no risk to your brain or any major blood vessels or nerves.
2) There is no risk to your general health. This is an aesthetic operation.
3) This surgery does not affect the circulation to your scalp or head.
4) There is no risk of any hair loss.
5) The recovery is fairly quick, just some swelling on the sides of the head that looks pretty normal in a wee. There are no restrictions after surgery.
6) You could return to contact sports within two weeks after surgery.
7) I will have my assistant Camille pass along the cost of the surgery to you later today.
The biggest issue in performing temporalis reduction surgery is that fine line incisions are needed on the side of your head to perform it. These incisions do not cause any hair loss and I do not shave the incision line to perform them.
Dr. Barry Eppley
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