Can Temporal Reduction Help Narrow My Head Width?
Q: Dr. Eppley, I am interested in temporal reduction. (head width narrowing) Since I am a young child I haven had a serious problem with the shape of my head. It is almost totally flat at the back and bulges out quite a lot not just above my ears but at the whole temporal area, because of the permanently wrong sleeping position as a baby. Now I am 21 years old and my head width is 177-178 mm , while the average male human breadth is about 150-155mm (depends on ethnicity and height). I am 183 mm tall and in my whole family there is no such a case like me so that it is definitively no genetic reason for that excessive width. Furthermore there is an asymmetry as the right temporal region sticks out for about 3-4 mm more than the left side, so that when I haven’t long hair it can be seen. Now my two questions:
1) Is it possible to reduce the temporal region in order to make it more acceptable ?
2) How much would it cost as it is not just a small bulge but an area with about 40 to 50 square cm on each side? I have attached pictures of my head with line drawings so you can see what I am talking about.
A: Temporal reduction can be an effective head narrowing procedure in the properly selected patient. A bulging side of the head is made up of a combination of temporalis muscle and temporal bone. While many perceive that the problem is too much bone, the reality is that more than 50% of any temporal convexity is muscle. The smaller the amount of temporal convexity, the more that the attachment and thickness of the muscle is the problem. Your pictures show a mild to moderate temporal convexity (in my experience) which indicates to me that a muscle reduction/shortening would be an effective solution.
When it comes to temporal muscle reduction, there are two approaches…injectable Botox and surgical reduction. Botox injections can work for permanent reduction in the thickness of the muscle and has the advantage that it can work on any area of the muscle. Its disdvantage is that the result from its use take time, require multiple treatment sessions and may not work for everyone. Surgical reduction produces an instantaneous result by permanently and immediately removing a portion of the muscle. Its disadvantage is that it does require small vertical incision and can not reach all areas of the muscle.
When you look at your side diagram with your drawing, surgical reduction can reach the back half of that drawing but the thickness of the muscle at the edge of temporal hairline and in the non-hair bearing skin to the side of the eye is beyond what surgical muscle reduction can reach.
Based on your temporal areas of concern, you could either try a series of Botox injections or combine surgical reduction with Botox injections for the most forward part of the temporalis muscle.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.