Q: Dr. Eppley, I have a bulging blood vessel on the right side of my forehead. I have been told that it is an artery from a dermatologist and a vascular surgeon because it has a pulse in it. I want to get it tied off because it really sticks out and sometimes feels uncomfortable. How is this procedure done and roughly what percentage would you say were completely happy with the results versus some improvement versus not happy at all with the outcome? I would like to get an idea of what scarring can be expected. Any potential side effects specific to this procedure other than scarring? Read somewhere about a pretty important nerve that hangs around this artery, obviously you would avoid this, but what are the chances of any problems?
A: Ligation or tieing off of a prominent vessel in the forehead can be done to reduce its prominence. This happens because the flow through the vessel is cut off. The surgical approach for arterial ligation to a prominent forehead vessel is done through a small incision inside the temporal hairline (to get the anterior superficial temporal take-off from the main trunk of the superficial temporal artery) and a very small incision on the forehead where the most distal end of the branch can be seen. In rare cases, a third nick incision is needed in the forehead if there is an additional feeding branch) These are very small incisions and scarring is not usually a concern. The nerve to which you refer is the auriculotemporal nerve which is a sensory nerve that only supplies feeling to the temporal region. It is not an important nerve in that it is not a motor nerve responsible for facial movement. That nerve is identified and preserved as the dissection is done in the temporal region while searching for the anterior superficial temporal artery branch. The primary risks of the procedure is how well it works, reduction vs elimination of the visible artery.
Dr. Barry Eppley