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
Q: Dr. Eppley, I read an article about temporal muscle reduction and it said that 70% of their clients died after two years, due to the surgery. Now I don’t know if it was specifically talking about shrinking the muscle. My question is, has this procedure been tested safe for people, because us people should not be put under the knife for a surgery which has been invented just recently and doesn’t have enough evidence to know if it’s safe or not. And is cutting and shrinking the temporal muscle dangerous? will it cause infections, brain damage, dead blood vessels, cancer and so on…
A: When it comes to aesthetic temporal reduction, primarily by muscle reduction/shortening, your perception or readings on it (of which I am not aware anything has ever been written in the medical literature in regards to aesthetic temporal reduction) are grossly inaccurate. You are obviously confusing intracranial vs. extracranial temporal surgery. Temporalis muscle reduction is very safe and effective. as it is done on the outside of the skull. The only issues are aesthetic, the need for a fine line vertical incision in the temporal scalp and how much tenporal reduction can be achieved.
Dr. Barry Eppley
Q: Dr. Eppley, I have just visited your website and it gave me some hope. I saw the archive where you response to people’s problems. I thought that I may try to ask you some questions. I attached the photo of my head and as you can see it is not proportional. I really do not like that my head is so wide and the forehead is so high. Could you tell me what kind of surgery operations I need to get my head look better and be smaller certainly. I thought about temporal reduction, cheekbone reduction and maybe lowering the hairline. I think temporal is the worst thing, not only muscle but I feel the bone aboue ears … I would like to know your opinion what can be done and what kind of effect I could expect. The last and probably the most important question is about the price of surgeries you suggest 🙂 I hope you will give me a hope for better future 😉 Thanks in advance!
A: The most improveable feature of your concerns, and the ‘easiest’ is the temporal reduction which narrows the appearance of the transverse width of the head. While it does require some vertical incisions on the side of the head., much of the temporalis muscle can be released with some bone reduction to make for a visible narrowing. (see attached imaging prediction) Hairline lower is not really an option for you unless you have a first stage scalp tissue expander placed to create more scalp tissue top bring forward. Cheekbone reduction can be done through an incision inside the mouth (and the back part of the zygomatic arch moved through the temporal incisions) but the usual inward movement averages about 5 to 6mms at best in most people.
Dr. Barry Eppley
Q: Dr. Eppley, My temples bulge out too much and I know it is the muscle because it gets worse when I clench my teeth together. Is it true that the less your muscle expands and contracts when chewing, the thinner it is? If I use my mouth less will the muscle shrink? Is surgery the only method to reduce the size of the temporalis muscles? How much would the surgery cost please, and would the muscles be taken off by excision? What risks are involved?
A: Like all muscles, size is somewhat dependent on use. But one would have never open their mouth again to have the temporalis muscle shrink in size.
The non-surgical approach to temporalis msucle reduction is Botox injections. It would require a series of Botox injections done 4 months apart up to a year to get teh muscle to shrink. Presumably this would be permanent but that is not assured.
The temporalis muscle is released from behind the ear and at the top of the skull, 4 to 5 cms removed and then retacked done through a vertical incision in the hairline above the ear. The only real risk to the procedure is in how much correction (reduction in convex profile) can be achieved. It does not affect mouth opening or movement. Its total cost for both sides is in the range of $6500.
Dr. Barry Eppley
Q: Dr. Eppley, I have rather convex temples that I’d like to be thinned please. My widest points appear to be at the upper squamous temporal parts, between the hairline and the ear (beyond hairline but visible still), and on the latitude 1mm above the brow.
1) If you know roughly which point in the temporal area I’m talking about, is convexity in that area governed by temporalis muscle thickness or convexity of the squamous temporal bone itself.
2) If it is due to the muscle, then from your experience, is the muscle in that area thick at all? Is 4mm a realistic amount that can be taken off at that very point on either side of my head?
3) If it’s a possible procedure, is it an internationally recognized cosmetic surgery procedure?
A: To answer your questions in regards to temporal reduction surgery:
1) The temporal area to which you refer is exclusively controlled by muscle thickness. The temporal bone is naturally concave in that area and has a little significance on the external shape of the temporal area.
2) The temporalis muscle is an exquisitely thick muscle, easily approximating 10 to 12 mms thickness in that area.
3) Temporal reduction is not a common aesthetic procedure and is probably performed by very few doctors in the world.
Dr. Barry Eppley
Q: Dr. Eppley, I had muscle reduction done for my very bulgy temporal areas six weeks ago. While there is already visible improvement, I do have some minor concerns and wanted to know if what I am experiencing is normal. I have noticed that the temporal area in the non-hair bearing portion above the cheek arch seems to be a llittle bigger than before. It is soft and fleshy and does not hurt. Will it stay this way or go down with some more time? Also my mouth opening seems to be lityle less wide than before. I have no problem eating and speaking but it does not seem to go as far open as before. Will this stay this way or will it eventually return to normal? Right now it measures 38mms between my front teeth when I open as wide as I can.
A: Seeing the final result after temporal muscle reduction is a process that takes up to six months after surgery to see the final contour result. So at six weeks you have a ways to go. But to address your two specific concerns:
1) That bulging just above the zygomatic arch is very typical at this point. The muscle has shortened so the bulk of it, for now, is in this area. This is where the muscle passes under the zygomatic arch and is it’s thickest part. Also it also may appear bigger (even if it is not really bigger) because what was above it has gotten smaller. So it may be a relative perception issue. Like above, I wait for the full six months to see how the muscle changes.
2) So-called normal oral range of opening is 45 to 55mms. for most people. (I just measured mine and it was 48mms) Anything over 30mms is very functional and would not cause issues with eating or speech. I don’t know what you were before surgery but i suspect maybe 10 to 12 mms more. I would g ahead and work on some daily stretching of it to see if you can get back up to 40mm plus. I suspect you will be able to do so.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to have my temporal muscle on both sides reduced. They are overdeveloped and makes my face look awkward. I would like to have face proportioned right on both sides. Please tell me some options that I might have. Thanks.
A: Thank you for your inquiry and sending your pics. Yes you do indeed have very big temporalls muscles, probably one of the biggest that I have ever seen by proportion to the rest of the face. The largest portion is just above the zygomatic arch where the bulk of the muscle lies. It is the bulge between the side of the forehead and the position of the zygomatic arch that is aesthetically disproportionate. A line drawn between the two should be either straight or have a slight concave curve to it. Significant convexity of the temporal area makes it stand out and be very noticeable.
Reducing the size of a temporalis muscle is a very rare procedure. I have done a lot of cosmetic temporal surgery, all of which has been to create the opposite effect of temporal augmentation. The only option to reduce the temporalis muscle size is surgical through reduction and thinning of the muscle. You need an approximate 50% reduction in the size of the muscle. This would need to be done through a scalp incision approach to access the attachments of the muscle to the skull to lift and thin it. This would create actual muscle debulking and reduce the visible bulge.
Dr. Barry Eppley