Anterior Temporal Reduction

Q: Dr. Eppley, I have benign temporalis muscle hypertrophy on the sides of my forehead.  It adds width to my forehead which gives my forehead a kind of alien shape. I know it is the temporalis muscles as when I fully open my mouth I achieve a very desirable atrophy which diminishes the odd looking alien shape. I would like to have this problem dealt with surgically as I want the problem fixed permanently.  I am aware Botox is an option. However I have a few questions about the surgery.

1 )Does this surgery have a high satisfaction rate?

2) Is there a possibility that it could look un-even or potentially worse?

3 )Are there any potential side effects after the surgery?

4) The muscle hypertrophy is benign, does this make me a more suitable candidate even if it is the anterior part?

5 )Why do other surgeons not use the cauterisation technique you use and would that be necessary for my procedure?

I look forward to hearing back from you.

A:  I am very familiar with the temporal shape issue which you have described. You are referring to a anterior temporal muscle reduction which is far less commonly done than that of posterior temporal muscle reduction for head narrowing. The anterior temporal reduction poses far greater challenges than that of posterior temporal reduction for the following reasons; 1) incisional access is more aesthetically challenging, 2) the muscle can only be partially reduced/released (unlike the posterior procedure where the entire muscle is removed. This poses technical challenges and 3) it is on an exposed non hair-bearing part of the face where the effects of the surgery can be readily seen.

Anterior temporal reduction is done somewhat similarly to that of the posterior temporal reduction technique that I developed. From a vertical incision back in the temporal hairline, a subfascial approach is used to release some of the superior muscle attachments to the anterior temporal bony line of the forehead. Then cauterization points are done along the length of the muscle from the forehead down to the zygomatic arch. Unlike the posterior temporal technique the muscle is not widely resected as that would leave to a major temporal hollowing effect. The anterior technique relies on muscle thinning and not resection.

In answer to your specific questions:

  1. The anterior temporal reduction technique has not been done as frequently as that of the posterior temporal area which has a near 100% satisfaction rate. I have only done it a handful of times from which I have not heard any issues about lack of effectiveness.
  2. I don’t know if it can be made to look worse. I think the risk lies more in its effectiveness, was enough of a reduction obtained.
  3. There will be some temporary jaw opening discomfort and stiffness on mouth opening.
  4. The origin of the temporalis muscle hypertrophy does not affect one’s candidacy for the procedure.
  5. I can not speak for what other surgeons do. My technique has been described above.

Dr. Barry Eppley

Indianapolis, Indiana