Can I Safely Have Temporal Artery Ligation?

Q: Dr. Eppley, I am interested in temporal artery ligation. I have an artery (or arteries) with small broken capillaries around it on the right side of my forehead. It weekly bulges and swells, then goes down a little over five to seven days. This has been going on since January. It never completely disappears. I’ve seen a dermatologist (who will not laser arteries), my general practitioner (who ruled out temporal arteritis) and a vascular surgeon (who says it’s not disease). I then consulted with a plastic surgeon in my area. He said he could ligate at the hairline but when I questioned him about back flow or multiple vessels feeding the bulging area he admitted to being uncomfortable doing the procedure. The vascular surgeon had noted that unless he pressed right where the artery branched off the main one the problem area did not collapse. I feel at a loss. I don’t want to do more harm then good but I’m uncomfortable with it’s appearance. I would love your opinion. Hopefully you can help me. I have attached a picture of the bulging artery.

A: It appears that you have a prominent branch of the anterior temporal artery. You are correct in assuming that it is best t have at least a two point an sometimes a three point ligation approach. That can be determined by an actual physical examination right before or during the procedure. Your plastic surgeon’s concern is the fear of potentially injuring the frontal branch of the facial nerve as it crosses the temporal area between the hairline and the eyebrow on its way to the forehead. Fortunately that small nerve branch runs anterior (in front of) where your bulging artery is located.

Dr. Barry Eppley

Indianapolis, Indiana