Q: Dr. Eppley, I have some questions/concerns about a forehead implant on what can be done over it after it is in place. Would I be able to have Botox injections in my forehead after getting the implant placed by you? Or would this inhibit the ability to do Botox injections there? I also will need a thickening hair transplant in the very corners (temples) which I will do after we do the forehead implant but I want to be sure the transplant can still take to the forehead even if the implant is directly underneath it because I want the forehead implant to raise high up.
A:You should have no problems with getting Botox injections after having a forehead implant placed…as long as the injectors knows not to inject down to the ‘bone’. (that would be a waste of Botox and risks implant infection) Botox injections are placed right under the skin into the muscle not deeper. Also doing further hair transplants after getting a forehead implant is no problem since the implant sits well below the skin level down at the subperiosteal plane. Everything aesthetically you want to do after this type of facial implant is placed is more superficial to it and is perfectly safe.
Dr. Barry Eppley
Q: Dr. Eppley, I saw that you mentioned that Botox injections to the posterior temporal area is a possible alternative to surgical resection. I am personally quite interested in this approach, as I’d like to avoid surgery if possible. A few questions:
1. Would the effect after a few sessions be permanent? You mentioned that the posterior temporal area is not used much in chewing, so would this mean that the shrinking of the muscle would stay?
2. Would there be any risk of the Botox ‘spreading’ to the anterior temporal area and causing a hollowing effect?
3. How much temporal width reduction can be achieved with Botox compared to surgery?
Thanks for your time.
A: Like all masticatory muscles, Botox injections can be done to induce muscle atrophy. How permanent the effect size reduction would be is unpredictable. The posterior temporal muscle is much thinner than the anterior temporal muscle but whether the effects of Botox injections is more profound or more permanent is unknown. Botox injections do not migrate more than that of a 1 cm diameter from the point of injection. Compared to surgery, Botox injections at best would produce only about half the the thinning effect of total muscle removal.
Dr. Barry Eppley
Q: Dr. Eppley, I have always felt that the areas right inferior to my zygomatic archs are way too thick and hard and widened.I am not sure about the specific name of that muscle, but pretty sure it is not due to bone.I know that Botox is commonly used to reduce jaw angle, but I don’t even have an angle so I don’t know whether it will help, as it is like the area above masseter muscles (or it really is upper masseter muscle?).
A: Botox will not be an effective or prudent treatment for the area you have highlighted for the following reasons:
1) There is a significant risk that Botox injections placed in this area will inadvertently paralyze the frontal and buccal branches of the facial nerve, thus rendering your forehead, eye and upper lip areas paralyzed for the duration of the effects of Botox. (around 4 months)
2) The upper masseter muscle in this area is largely more fascia than muscle thus making it far less responsive to reduction than that of the jaw angles
The effective method of reduction would be check bone reduction (zygomatic arch reduction) to carry the attachment of the soft tissue inward with the bone.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 39 year old male who had a left-sided sphenoid wing meningioma removed two years ago. The temporalis muscle didn’t reattach properly and is bunched above the zygomatic arch. I was wondering if you had experience correcting this asymmetry. You mention patients not losing function with a reduction of the posterior temporalis. Have you had the same results with the anterior temporalis? I’m am going to get Botox injections into the muscle bulge in a few weeks. If this doesn’t work well what are my surgical options? Thank you very much for your time.
A: Your pictures show well a detached anterior edge of the temporalis muscle which has contracted and bunched up done at the zygomatic arch as you correctly surmised. Since it is not possible to free up the muscle and stretch it out and resuspend it, temporal muscle reduction of the bulge would be the only treatment approach. Unlike the posterior temporalis, the large anterior belly of the temporalis muscle does carry with it some greater functional significance since it is attached directly to the coronoid process of the mandible. I think the approach of Botox injections is worthy of an initial treatment approach. Sometimes that can work extremely well while in others other moderate muscle reduction is obtained. This muscle bulge can be reduced surgically and that may be reasonable with augmentation higher up in zone 2 of the muscle since that now has more hollowing than the other side due to the muscle retraction. But I would first see how effective Botox may be before considering that approach.
Dr. Barry Eppley