Q: Dr. Eppley, I hope you will respond to my question. I am scheduled for temple augmentation with your designed temporal implant and was curious to know the recovery time? I have had cheek augmentation recently(2 months ago) and found the swelling stayed longer than anyone explained. Should I expect the same swelling with this implant? How long? Are there any photos of temple implant recovery?? Is this a new type of implant?
A: Since you are not my patient, my first answer to your temporal implant augmentation question is that these should really be answered by the surgeon you are trusting to do the procedure. He/she should be able to fully explain these questions if they have had experience with the procedure.
That being said, temporal implant recovery will be quicker than that of cheek implants. As you have now learned, full recovery from any type of facial skeletal augmentation will take a full two to three months. Your surgeon should have made that clear before your surgery. Any form of facial implant surgery always takes longer than any patient believes or is told. However since temporal implants are not a bone-based surgery but a muscle one, the recovery is much quicker with a faster resolution of swelling and to get to the point of seeing the final result.
Due to patent confidentiality, patient photos are not shared.
The temporal implant is not a new implant as defined by just coming out. It has been commercially available now for over three years.
Best of luck with your surgery,
Dr. Barry Eppley
Q: Dr. Eppley, I have a very narrow, dolichocephalic skull shape and I would like to increase the width of my head. According to the information on head widening provided on your website there are two options to achieve this:
1. Augmenting the posterior part of the temporalis muscle by injecting fat.
2. Placing an implant under the temporalis muscle above the ears.
I prefer option 1 since I would like to avoid implants. However, if the achievable results of fat injections are unsatisfactory I will gladly consider alternatives.
Thus I have the following questions:
1. By how many millimeters can the head be widened through fat injections to the posterior aspect of the temporalis muscle? Are 5mm per side achievable?
2. How much would the procedure cost if i) only the posterior part and ii) both the anterior and the posterior part of the temporalis were to be augmented?
3. How much does it cost to widen the head using semi-custom-made implants with a thickness of 5mm per implant?
4. Are there any other methods to increase the head without producing visible scars?
Thank you for your time.
A: The short answer to your question about head widening through posterior temporal augmentation is that only an implant is going to consistently work. The first issue with fat that you have to have enough to harvest, process and then inject. In a thin person, which it appears you are, that could be the rate limiting step right there. No matter what is injected only a fraction will survive and what survives most certainly is not likely to be symmetric.
The use of a semi-custom temporal widening implant is assured, can easily increase the side width by 5mms and is placed through an incision that is limited to the back of the ear. (thus being placed in a scarless fashion) Any consideration of fat injection use should be limited to the temporal hollowing located next to the eye area (anterior temporal augmentation) where a more posterior implant does not reach. There are very effective implants for that area as well but they require a more exposed vertical incision in the temporal scalp region.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in temporal implant augmentation. I am a 35 year old male who ever since I was a child I have had one temple that was somewhat misshapen and sunken in. As I have gotten older and lost my baby fat, in addition to becoming leaner all around, it has become more and more noticeable and the way it looks bothers me. I see you have temporal implant treatments and I am wondering what the general ballpark amounts are for something like this. Keep in mind that only my left side is abnormal.
A: A very simple and effective solution for temporal hollowing is a temporal implant. Placed in the subfascial plane on top of the temporalis muscle, it can immediately add permanent volume to temporal hollows. For just one side, it can be placed in a 30 minute procedure under local or IV sedation. There is very little swelling and no recovery afterwards of any significance. I would have to see some pictures of your temporal hollowing to determine its extent and exact location. Temporal implants work best for when the hollowing is deepest in the temporal region just above the zygomatic arch.
Dr. Barry Eppley
Q: Dr. Eppley, I had a cranioplasty on August 2012 after having a craniotomy in June. A of now I have temporal wasting of the muscle on my right side and a serious indention where the muscle should be. My neurosurgeon says thats because the temporal muscle has fallen down and is being clinched in a spot right above my ear. Is there anything we can do for the muscle, to try and get it back to where it was preinjury?
A: What you now have is a combination of temporal muscle atrophy and shrinking as a result of the muscle losing its superior attachments. At this point the muscle is one shrunken scarred mass and there is no stretching it back out and resuspending it. The muscle is now forever shortened and scarred. So trying to move the muscle back up will never work. The correction of the temporal defect will now require the use of a temporal implant to fill the defect.
Dr. Barry Eppley
Q: Dr. Eppley, I feel my face is a little weak down around my jawline area. Iwas hoping to have a more masculine jaw with out elongating my face any more… just maybe make it more full. Also as you can see on my photographs, my face is very asymmetrical. My right temple seems sunken in so was researching your page and saw you have a temporal implant, was wondering if I good candidate for the procedure. And last but not least, my nose is also very asymmetrical. If I feel above the nostril I can feel more cartilage on the left side of the nose and my right doesn’t have any. I am open to suggestions please if you can let me know the procedure you believe I will benefit from.
A: From a jawline standpoint, there is a clear chin deficiency but with a slightly long (rotated backwards) chin as well. While an implant can be used and probably not lengthen the chin, the most ideal treatment is an osteoplastic genioplasty where the chin can be brought forward and shortened as well. I have imaged that potential change in the attached profile pictures. In addition, I have also added some small jaw angle implant in the front view to see if widening the posterior jawline is also aesthetically beneficial.
As for your nose, I can see a slight retraction of the alar rim upward creating nostril asymmetry. That would also account for the differences you feel in the lower alar cartilages in the tip of your nose. This could be improved by the addition of an alar rim/onlay graft to the right side of the tip of the nose.
As for the temple areas, I am having a hard time to seeing the amount of asymmetry between the two sides. This may be a function of the photograph. For temple asymmetry, a small subfascial temporal implant can provide a moderate amount of augmentation to the more depressed side.
Dr. Barry Eppley
Q: Dr. Eppley, I have read a recent blog post of yours about an implant for the treatment of temporal hollowing with great interest. I have a depression on my left temple as a result of a craniotomy performed to clip an unruptured brain aneurysm. I would like to know more about this implant including the manufacturer, case studies of its use, and any before and after photos if available. Many thanks for your help.
A: The new temporal implant to which you refer is manufactured by Osteosymbionics in Cleveland Ohio. While it is not the first temporal implant ever designed, it is unique due to its shape and flexible design. You would have to contact the company for their clinical experience to date. I have not yet used this implant although I have used about every conceivable material for temporal augmentation and reconstruction. The material of this implant is a soft and flexible elastomer, which is what composes the vast majority of facial implants used.
For temporal defects from craniotomies, the size and extent of the depression must be carefully assessed and the implant matched to it. Some defects are due to mild to moderate atrophy of the temporalis muscle. This will appear as a more central indentation most prominent above the zygomatic arch and to the side of the forehead. An implant like this new temporal one may work well for this type of depression. Other temporal defects are bigger and are due to atrophy and a retraction of the attachments of the posterior and superior skull attachments. This creates a larger temporal depression and a bigger implant or other form of temporal reconstruction must be used.