How Can The Dent In My Temporal Area Be Fixed?

Q: Dr. Eppley,I’ve heard a lot of great things about your work, and I wanted to reach out to you since I believe you are the best professional to assist me in this matter.

On the top left side of my head, I have a medium-sized indentation. It’s not a large area, but it makes a noticeable difference in how my head looks. What I’d really like is to add some volume there so the contour appears more even.

Unfortunately, about three years ago I found a physician and tried the silicone 1000 microdroplet technique, which I now feel may not have been my best decision. I don’t believe I have much of it there, but after the second treatment, the doctor told me it wouldn’t be possible to safely achieve the fullness I wanted that way. I also understand this could present complications in the future. Since then, I’ve been exploring other options.

From my research, I’ve considered two possibilities:

  1. A custom implant, placed through a hairline incision, possibly with removal of some silicone if that’s feasible.
  2. Fat grafting after removing some silicone, though I feel an implant might be more reliable.

I realize there are risks and limitations, especially with the presence of silicone, which is why I wanted to ask your opinion. I even sketched a quick graphic and included some photos.

I would really value your thoughts on whether something like this could work, or if there’s another solution you’d recommend and could assist me with.

A:Thank you for your detailed inquiry and sending your pictures to which I can say the following:

1) Your left upper temporal deficiency is clear in your pictures. Whether that represents a bone contour deficiency or a difference in the muscle between the two sides cannot be determined by a picture alone. But regardless of the actual anatomic nature of the deficiency the best procedure would be an under the muscle bone based implant to augment it.  That would have the least risk of any short term or  long-term implant related issues. What the dimensions of that implant would be would be able to be determined by a 3-D CT scan IF it is a bone base deficiency… Which I suspect that it is.

2) in a bone based implant under the temporal muscle the prior silicon injections would have no bearing or adverse effect. As you have mentioned the injected volume is likely very small and would probably not be an issue even if some form of implant augmentation was done on top of the muscle as opposed to under it.

What I would initially recommend is to get a 3-D skull CT scan and really evaluate the anatomic nature of the problem. That will help guide what treatment approach would be most effective.

Dr. Barry Eppley

World-Renowned Plastic Surgeon