How Can I Best Reduce My Temporal and Zygomatic Width?

Q: Dr. Eppley,I came across your webpage on temporal width and zygoma reduction surgeries and had 4 questions about these procedures. 

I am looking to reduce my bizygomatic width as well as the width of my face above the zygomatic arches, and saw that you previously wrote 7.5mm per side maximum can be reduced in the zygomatic arches so I was wondering what might affect this maximum between individual skulls, since I am concerned that in my case it may not be possible to achieve the reduction in width I want (roughly 7-8mm both sides) as well as if moving the arches inwards too much would cause issues with the temporalis or masseter muscles below. 

I was also wondering with regard to the temporal width surgery, if you ever reduce the bone underneath, since my temporal fossa bulges more in comparison to the typical flat shape (I attached an image from my CT scan to demonstrate this), as well as if you are limited to reducing the posterior part of the temporalis.

A:In answer to your questions about facial with reduction:

1) I have yet to see any impingement on the temporal muscle from cheekbone reduction osteotomies no matter how much it is moved inward. I suspect this is due to the overlying fascia of the temporal muscle. The bone can be pushed inward as far as being up against the fascia but it can move no further. The temporal muscle lies inside the fascia,  as a gliding muscle, is therefore not impinged. This is very different from zygomatic arch fractures in which the sharp end of the fractured bone penetrates the temporal fascia and induces muscle pain and the potential for mobility restrictions.

2) the facial/head width reduction surgery almost never is the temporal bone reduced. This is for one main reason and that is of access. Short of a bicoronal scalp incision there is no way to easily access the bone to do so. So even if one may benefit from temporal bone reduction the trade-off would be the  fine line scalp scar from ear to ear across the top of the head. The scar issue aside coming from above would certainly maximize the movement of the zygomatic arch inward, perform some reduction of the thickness f the temporal muscle as well as reduce the thickness of the temporal bone.

In summary the scarless technique, coming externally with arch osteotomies and some muscle reduction, may achieve your desired results but let’s assume that while improved it cannot reach your ideal goal. Conversely the coronal scalp approach maximizes what is obtainable and would be much more likely to hit your ideal aesthetic target. In the end it comes down to how much effort are you willing to put in for what type of aesthetic outcome.

Dr. Barry Eppley

World-Renowned Plastic Surgeon