Secondary Temporal Augmentation Replacement for Thinner Aesthetic Result

Q: Dr. Eppley, I had a temporal implant procedure done 10 years ago which I’ve not been happy with as the size and thickness of the implants is too large in my opinion. I would want them to be replaced with much smaller and thinner implants.

Some of the notes I have are:

– the original physician does not have records other than it was methylmethcrylate implants, formed from putty at the time of surgery

– I had a consultation with a physician in southern California, he concluded the methylmethacrylate implants are placed along the temporal bone bilaterally after reviewing MRI

– the MRI report is attached but is not too conclusive

– the right side implant is definitely a little thicker, more convex shape than the left side, I particularly dislike the right side result

– I’ve attached 3 pics, the first one I think shows how the result makes my head look bigger which I don’t like, an extremely subtle augmentation is what I’d prefer.  The sideview shows the faint scar line.

A: Thank you for sending all of your prior temporal augmentation information. As I suspected these are PMMA intraoperatively fabricated implants placed under the muscle down on the bone….a common technique done before the availability of standard silicone temporal implants. I could easily identify in your pictures the surgical incision used. Knowing its location and length would be crucial in determining how ‘easy’ it is to revise/replace them. It is one thing to place a moldable putty through a small incision and shape it and allow it to harden than it is to try and get a solid implant out in reverse. It can be how to extract the proverbial ‘ship in a bottle’. However knowing that PMMA is usually inserted through ‘larger’ incisions, which I suspect you have, suggests that it can be similarly removed. 

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry L. Eppley
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Board Certified Plastic Surgeon