Q: Dr. Eppley, I am interested in having superficial temporal artery ligation done. I’m a 30 year old male who over the past year I’ve lost weight and workout very frequently, which I believe has caused the superficial temporal artery on one side of my forehead to become very prominent. I’ve been checked out by a vascular surgeon and there is nothing medically wrong that is causing this. I’ve subsequently consulted with two plastic surgeons who’ve both said they don’t recommend having this removed. It’s really become bothersome to me. In searching, I found that you have provided information about performing this procedure. Do you consider this procedure safe or what are the possible risks? I guess I’m wondering why other plastic surgeons seem so reluctant to do this. Is there a possibility I could travel to your location to have this procedure done? I greatly appreciate any help you can provide. I’d really to do something about this issue and am hoping you can help.
A: Superficial temporal artery (STA) ligation is a fairly simple procedure that is often done under local anesthesia. There are no significant risks in doing it other than the small scars needed to access the artery to tie it off. Generally there needs to be at least two points of ligation to prevent backflow and return of the visible pulsations. One of these small incisions is always in the hairline and the other one or two is determined by the course of the artery beyond the temporal hairline. STA ligation is done under local or IV sedation anesthesia. There is no real recovery from the procedure as no swelling or bruising usually occurs. As this is an uncommon aesthetic facial procedure and patient request, most plastic surgeons have most likely not performed it.
Dr. Barry Eppley
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
Q: Hi, I am located out of the United States. I am 42 years old and have a temporal artery on the left side of my head that has become very prominent over the last year and I am looking for someone to do a temporal artery ligation. I came across a forum where Doctor Eppley was commenting on the procedure saying that it was relatively straightforward. I would like to know if this is a surgery that he could do for me. I would be willing to travel to Indianapolis for it.
A: The superficial temporal artery (STA) branches off of the main trunk of the temporal artery just above the ear. It then courses forward until it crosses high in the forehead from the temporal hairline. It leaves the camouflage of the hairline at this point to cross into the forehead skin. For most people the STA is not usually seen although it can be palpated in the temple or forehead region. In a few people it becomes more noticeable. Whether this is because it is just simply more superficial or actually enlarges in size is unknown.
The STA can be ligated to eliminate its pulsatile visibility. However, it has to be done both high and low to prevent backflow. That may mean that the high ligation point may not be in the hair-bearing temporal scalp and require a small skin scar. Loss of the STA causes no known problems so it can be ligated without any vascular consequence.