Can I Have Temporal Reduction On Just One Side?

Q: Dr. Eppley, I am quite determined to have temporal reduction surgery done (head width reduction), but there is still a couple of lingering question I need answered. I have attached several CT scans of my head to get a better visualization on the width of my muscle as well as my skull. I was born with positional plagiocephaly. This has caused my head to be misshaped and one side of my face is wider than the other side. Initially, I was thinking about getting the head width reduction for both side of my face, however, after a careful consideration I want to focus the head width reduction on just the right side of the face on the wider side. If the result of the reduction is significant, I might consider a reduction on the other side of face as well as jaw and chin bone reduction on the wider side of the face. One of my main concern of the reduction is how much the width can be reduced. I recently took a CT scan of my head and I found that the size of the temporalis muscle at the widest area of my head isn’t very thick being about 6mm. Thus I felt through only muscle reduction there might not be as significance of reduction compare to when if both muscle and bone reduction is performed at some region of my head. Also I recalled last time we talked that you told me that you are not gonna remove a lot of muscle you simply reattach it and let it shrink. Since the temporalis muscle at some of widest regions of my head is only 6mm, I felt the shrinkage of muscle won’t likely achieve my desire width of reduction which is between 5mm to 7mm on the right side. Thus, I wanted to see if I can completely remove the temporalis muscle on that side above the ear.

A: It appears you have misinterpreted how I do the temporal reduction surgery. I initially detach and remove the posterior muscle in its entirety, then detach the rest from the temporal crest, shorten it and reattach it lower. So the entire posterior muscle is removed. That is critical to get a very visible width reduction from 5 to 7mms based on the thickness of the muscle present. Bone reduction is done based on what the CT scan shows although it is never as significant usually as the muscle reduction, but it is an additive component to the overall width reduction. Certainly only one side can be done if desired and, in cases of asymmetry, met be the best initial approach.