Q: Dr. Eppley, I am interested in temporal reduction surgery. I have too much width of my head. So I wanna reduce width and do your surgery that removes temporal muscle and/or reduces the underlying skull bone .I think the back of my skull needs more volume as well but I want to take surgery that reduce skull width first. I am sure I need surgery seriously as soon as possible.I think I need upper side bone reduction and lower side bone or bite muscle reduction. I am 30year old male living in Japan. I also wonder whether Botox injections that reduce bite muscle is safe and effective or not. Thanks for taking your time to read this.
A: Posterior temporal reduction (mainly muscle with some bone) can be an effective head width reduction procedure. (it is also the only one that can be done) While Botox injections may have some mild effect on muscle reduction, the amount of Botox that would be needed would eventually be greater than the cost of the surgery, would need to be repeated and at best would only create about 1/3 to 1/2 the effect of surgical reduction. But Botox injections are certainly safe and effective, it is just a question of their cost over time in such large muscle masses.
Dr. Barry Eppley
Q: Dr. Eppley, I have heard about temporal reduction and I know you are an expert at it. I was wondering if its possible to reduce the size of a WIDE head from the front view. I realized also when I fully open my mouth my head looks smaller compared to when my mouth is closed. I hate my head and was wondering how long is the down time for this surgery?
A: Temporal reduction is an interesting aesthetic skull procedure that few patients or surgeons have ever heard of. Your description of seeing head width improvement when opening your mouth is due to the thinning of your temporal muscles on the side of your head. They lengthen and narrow when opening one’s mouth widely. Thus you would need reduction of both the anterior and posterior bellies of the temporal muscles. The posterior temporal muscles can be surgically reduced from an incision behind the ear in the postauricular sulcus. Th larger anterior temporal muscles can not be surgically reduced but often respond well to Botox injections. Complete head widening by total temporal reduction is done by a combined procedure of surgical posterior temporal reduction and anterior temporal muscle Botox injections. This procedure surprisingly has very little if any downtime.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 28 year old Asian male interested in head width reduction. I have received a consultation in the past, where I was told the surgery I needed would be very dangerous and expensive potentially even lethal. Is your procedure different? I believe my face is otherwise fine except I have a very wide head above my ears. I have a smaller chin so my head appears unbalanced. Would I benefit from surgery? I noticed you also use Botox to good effect. Could I try the Botox first to see how it looks and then go with the surgery if the result is good? Looking forward to your advice.
A: The statements that you have been told about posterior temporal reduction (head width reductio above the ears) are completely untrue. There were obviously made by surgeons who have no experience in this type of surgery nor understand the anatomy of the area. The majority of the width of the size of the head is made up of muscle not bone. The posterior temporal muscle width is as much as 9mm in thickness. When this is reduced through a very straightforward and effective procedure with no side effects and very minimal recovery, the change in the width at the side of the head can be dramatically different. If you do the math, up to almost a 2cm width reduction in head width can be achieved. This is particularly true in Asians males where the thickness of the temporal muscle is quite significant. There are no adverse functional effects on jaw opening by removing this portion of the muscle.
While you can certainly do Botox first, it will not create the same head width reduction effect as this type of surgery. But there is never any harm in doing so.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in temporal reduction surgery. I was wondering if a complete reduction of my temporal muscle (including the non skin bearing part) was possible? And if so would it only require a surgical procedure? Or also a botox injection on top of that? Thank you very much for your time.
A: When you speak of complete temporal reduction of the muscle I am deducing from your description that you mean both the anterior and posterior temporal areas. The anterior temporal region is the skin bearing portion of the temporal muscle to the side of the eye that extends a few centimeters back into the temporal hairline. This temporal area can not be reduced surgically due to its thickness and location. It is treated by Botox injections to shrink down its size. The posterior temporal region extends behind the anterior area the whole way to the back of the head. The larger by surface area but thinner posterior temporal muscle area can be surgical reduced very effectively. Thus, surgical temporal reduction refers to the posterior area above the ears while injectable temporal reduction refers to the anterior region closer to the side of the eye.
Dr. Barry Eppley
Q: Dr. Eppley, I’m wondering if you can help me…. I’m currently exploring my options. I have recently inquired about what surgery can be done to reduce the width of my head. Other doctors have suggested Botox and also an earfold treatment to pin my ears back. I’ve noticed on your site you do temporal reduction by removal of muscle. My hairline is thinning and I’d be concerned about the scars. A lot of the my width of my head is the muscle as I can move it upwards and see a huge change. I’ve pasted an extraction of part of your website… is this actually possible to do it from an incision behind the ear? I’ve attached a picture for you to review.
A: The most effective and quickest method of narrowing the sides of the head is a temporal reduction procedure where the posterior belly of the temporalis muscle is removed. While I initially developed the procedure using a small incision in the temporal hairline, more and more patients over the years who shaved their heads or had close cropped requested the temporal reduction procedure. It became necessary to find a completely ‘scarless’ way to do the temporal reduction procedure. Just like inserting temporal implants to widen the head, a temporal reduction procedure can also be done through a postauricular incision that sits right in the crease at the back of the ear.
Dr. Barry Eppley
Q: Dr. Eppley, I am going to surgically contour my facial bones, specifically from the zygoma and below. Unfortunately, where I am going they do not do temporal reduction bone surgery. So in order to achieve the look I am going for, long and thin, I was wondering, to what extent may the sides of my head be reduced without removing a lot of muscle, mainly temporal bone?
A: Contrary to popular perception, temporal reduction is done by removal of muscle not bone. The fullness of convexity of the head above the ears is a combnation of bone and muscle but the ratio is weighted more towards the muscle and not bone. The thickness of the posterior temporal muscle in men can be anywhere from 7 to 1 mm thick. In contrast the thickness of the bone may be only 3 to 5mm thick. You can demonstrate this by getting a CT scan to see the tissue makeup on the side of your head.
To really make a difference in temporal reduction surgery, you remove the entirety of the posterior temporal muscle not burring the bone. Bone reduction will make little if any difference in its width, muscle removal can make it completely flat. Interestingly, removal of the posterior muscle has no long-term effects on mouth opening as the much larger anterior portion of the temporal muscle remains.
Dr. Barry Eppley
Can Head Width Reduction, Cheek Bone Reduction and A Custom Occipital Implant Be Done During The Same Surgery?
Q: Dr. Eppley, I am interested in getting head width reduction surgery, cheekbone reduction surgery as well as surgery to augment the back of my head. The first photo I attached is in regard to head width reduction and cheekbone reduction surgery. From the info on your website, I see you do removal of the muscle after the yellow line in my photo. I am curious to know if you can do removal of muscle after the red line in my photo. Also, I will always have very short hair on the side, since it make my head looks smaller. How visible will the scar be after the width reduction with my short hair?
I had a cheekbone reduction before but my surgeon didn’t reduce any more cheekbone after the first blue line in my photo due to concern of nerve damage. Since most of the width of my face is in between the two blue lines. The cheekbone reduction i had is largely ineffective in making my face more symmetrical and narrower. I was wondering if you are able to reduce the cheekbone between the two blue lines where my previous surgeon was concerned with nerve damage
Lastly is in regard to the augmentation of back of my head, my current head shape is similar to the baby in the second pictures. I am curious in getting a custom implant to make my head look more normal.I consulted with a craniofacial he advised me against a custom implant because of high risk of infection. How high is the infection rate of these implants, and How much will total cost of this specific surgery be including getting a 3d CT scan, a custom implant made, and all the other fees including surgeon fee?
A: When it comes to temporal muscle reduction, the actual line of reduction is from the top of the ear angling upwards to just behind the temporal hairline along the forehead, so it is in front of the red line that you have drawn. Most of the incision is behind the ear and it is done largely endoscopically above it.
The cheek bone a you are illustrating is the tail end of the zygomatic arch where it attaches to the temporal bone. If this part of the cheek bone is not fractured inward with the front part, little change in cheek bone width will result. An osteotomy is done in that area through a small incision at the junction of the beard skin and non-hairing skin. The temporal branch of the facial nerve runs in front of this incision so there is no risk of nerve injury. This is actually a standard approach to cheek bone reduction osteotomies as both the front and back ends needs to be cut and moved inward.
I have done many custom occipital skull implants as well as many other implants for other skull augmentation areas. I have yet to see an infection so the claim that they are prone to a high rate of infection has not been my experience.
Dr. Barry Eppley
Q: Dr. Eppley, the sides of my head stick out and are very round. But if I pull my jaw down the sides go flatter as shown in the attached picture. Hopefully this could be corrected with some type of temporal manipulation? Also I have a pointy sagittal ridge which hopefully could be rounded off. As you can see in the attached picture if I pull my jaw down and put my hand on the sagittal ridge I feel my head has a more aesthetically pleasing shape. This in my mind is achieved by flatter sides and a rounded top of the head instead of a point. Lastly I had put a side profile as I’ve got a mild lump that sticks out which hopefully could be smoothed out . Could you tell me if these correction are possible?
A: Unfortunately your pictures are so cut off (cropped) that I can tell very little from them. But by description, temporal muscle reduction would be helpful as you can see that this is a muscular problem as evidenced by when the muscle is lengthened by jaw opening. Since it appears some of the pictures did not come through, I can not comment on the skull issues other than to say that their description sounds very typical for being capable to be corrected by bone reduction. (sagittal ridge reduction)
Dr. Barry Eppley
Q: Dr. Eppley, I am a 26 year-old male from Europe. I have a major concern about the proportionate shape of my temples, specially above ears. The muscle in the region is very thick and also the bone is protruded to large extent which makes heads looks very big. So I have decided to contact you as I can see you are the only one having expertise in this area of plastic surgery.
I have some questions regarding this:
1) How much muscle can be reduced..does this involves any risk?
2) How much muscle can be reduced?
3) How about narrowing the width of the forehead near the hairline?
4) Will this make considerable changes in my appearance?
5) What will be the recovery time?
6) What will be the cost of the surgery?
7) Iit possible to come for consultation and surgery once as coming to US twice will not be feasible?
A: In answer to your questions about temporal reduction surgery:
1 and 2) Usually the entire posterior belly of the temporalis muscle above the ears is removed. This constitutes a thickness of at least 5 to 7mm per side, sometimes even more depending upon the thickness of the muscle. I have seen temporalis muscle as thick as 10mms in some patients. Removal of this portion of the temporalis muscle causes no functional loss of jaw movement or any other disability.
3) Reducing the temporalis muscle near the eye and just below the forehead is a different matter than that at the sides of the head. This muscle can not be surgically reduced. It must be treated with Botox injections if any reduction in thickness is to be achieved.
4) Changing the convex shape of the head above the ears to more of a straight line (and hence narrowing the head width) is seen by those so afflicted as providing major improvement in their concerns.
5) Temporal reduction surgery has a very quick recovery time with little discomfort and minimal swelling. The change in temporal appearance is immediate.
6) I will have my assistant Camille pass along the cost of the surgery to you on Monday.
7) There is no need to come initially for a consultation. All before surgery discussions etc can be done by e-mail or Skype video. You would only need to come for the surgery and could return home within 48 hours after the procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am 28 year-old Asian make who is very interested in having cosmetic surgery performed for overall facial reshaping. As you offer a wide range of procedures which may be relevant to my goals, I hope to receive advice on the achievability of my goals.
First of all, I am very conscious in photos of the roundness and wideness of my face. (especially when smiling, at which point my cheeks appear very round and prominent) In addition, I would like to reduce the fullness of my lower face and make it thinner.
Secondly, I was wondering if a sliding genioplasty was advisable, as my chin appears to be relatively normal sized. I wish to make my jawline less round, and increase the vertical dimensions of my face to alleviate the aforementioned wideness.
Thirdly, I was wondering if procedures were available to create a more ‘deep-set’ look for my eyes. This, in addition to rhinoplasty to reduce the hump and raise the nose bridge, to reduce the ‘flatness’ of my face in profile.
I realize that not all of my expectations will be realistic nor all procedures advisable, so thanks for your time and expertise in advance.
A: A wide collection of procedures are available for facial reshaping as you are aware. In addressing all four areas of your facial concerns from top to bottom, I can make the following initial comments as they relate to your face.
1) I am now using performed or custom brow bone implants to build up the brow ridges. They can be placed through a limited incision endoscopic technique. That is the most effective way to create a more deep-set look to your eyes.
2) Your rhinoplasty would include a humor reduction, radix augmentation and some slight increased tip projection.
3) Cheekbone narrowing is the only way to provide some reduction in the mid-arch bizygomatic distance of probably 4 to 5mms per side.
4) I would consider paranasal augmentation, I have a new paranasal implant that I am really happy with that can not be felt and adds about 5mms projection to the nasal base.
5) I do think that a vertical lengthening genioplasty (which may have to be widened in a male) will help narrow the jawline. You do not need a horizontal advancement but when opening the vertical distance of the chin it does rotate it back a few millimeters so I would do a small advancement as well.
These are some initial thoughts. Computer imaging needs to be done to see how such facial reshaping procedures would look on you.
Dr. Barry Eppley
Q: Dr. Eppley, I’m very interested in pursuing skull reshaping surgery to fix a congenital defect involving the right side of my skull. For as long as I can remember, it has been both a cosmetic concern and one of comfort. (causing pain/discomfort with prolonged lying on the right side or with wearing helmets of any sort). From reading your web-based article, I believe I may be a good candidate for your procedure. I’ve attached a few photos of the affected area for your review; of course it’s difficult to capture the magnitude and dimensions of the defect (a bulging, sharply angulated defect) with mere photos. I thank you in advance for your time and consideration.
A: As best I can tell from your pictures, the location you are referring to is the right parietal/posterior temporal region. You describe it as a congenital defect but also call it bulging. I suspect you mean a lifelong bulge in this area which is painful. This is very consistent in my experience with more of a temporalis muscle problem in that area. Most patients and even physicians have little appreciation of how thick the temporalis muscle is in that area and how far back it goes. It always feels like bone but there is a 5 to 7mm layer of muscle under exactly where you point. Having done a far number of temporalis muscle reductions/resections (temporal reduction) in this area for symptoms described just like yours, I can attest that your concerns are more likely muscular based than being a bone problem. A CT or MRI will show how thick the muscle is in this area. However, I often make the decision to do muscle resection/reduction based on the description and physical examination only.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about temporal muscle reduction surgery. My husband’s temporalis is very prominent when he chews and I was wondering if this is something to be worried about. He’s a healthy 25 year old and has no symptoms. Can this be fixed?
A: Having prominent, large or hyperactive temporalis muscles is not something to be worried about for any medical reason… unless one is having chronic muscle pain or spasm from their large size. Many men in particular have prominent temporalis muscles which can become very prominent in its convexity on the side of the head. The larger the lower jaw, the bigger the muscle has to be to open and close it. Thus, the bigger the muscle the more prominent it will be seen when in use from chewing when it maximally contracts.
Whether one should reduce the size of the muscle ‘(fix it’) by temporal muscle reduction surgery is an aesthetic concern not one of medical necessity. Some of the most prominent portions of the temporalis muscle can be reduced/thinned to reduce its bulging appearance (make the area above the ears flatter and not convex) without any effects on jaw opening and closing in my experience with this type of surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some type of temporal plastic surgery. As you could see from my pictures my temples are not symmetrical. Even though I was born with my temporal muscles having a natural arch, an injury on the left side tore that muscle At least that’s what I hypothesis. What are your thoughts, regarding an operation that will make my skull shape even again? Thanks for your time.
A: What I am seeing is that you left temporal region is larger than your left which is most likely due to a difference in the size of the muscles in that area. This can be approached by two different types of surgeries depending upon which side of your head you like the best. If you prefer the bigger left side, then a temporal implant can be placed from behind the ear under the muscle to make it bigger. If you prefer the right side, then a temporalis muscle reduction would be needed to make that muscle smaller through a vertical incision in the temporal hairline. Or if you don’t like the bulging on either side, then the temporalis muscle could be reduced on both sides.
Dr. Barry Eppley
Q: Dr. Eppley, I am a young man and I am embarrassed of the shape of my head. My head circumference is about 58 cm which seems to be only about 1-2 cm more than the average but the shape is abnormal- as it gets wider above the ears and temples on both sides. What is very surprising when I clench my jaw both sides of the head gets wider (about 0.5 cm) each side, and when I widely open my mouth both sides of the head get thinner and head looks almost normal. Would you be so kind to answer my questions. Is there any possibility to reshape my head on both sides. If yes what is the potential risk of such surgery- is there any chance to damage my brain, nerves, veins etc and is such surgery a big risk for my health and life? Does the surgery may affect in a bad way circulation of the blood in my head which my cause for example hair loss (it is extremely important for me to protect my hair because that is the only way I can mask shape of the head). What is the recovery time? I train bodybuilding and boxing especially the second one is obviously extremely contact sport- will I be able to continue my two passions and how long after surgery will I be able to come back to training?
A: What you are describing perfectly are thick temporalis muscles which is making a major contribution to the width that you are seeing above your ears and into the temple region. This is evidenced by the widening effect that occurs when you clench your teeth together (temporalis bulging) and why it gets thinner when you open your mouth. (stretches and thins the temporalis muscle) This dynamic head width changes indicate that a temporal reduction (temporalis muscle shortening/relocation procedure) would be very effective. This results in a 5 to 7mm change per side (1.0 to 1.5 cms transversely combined) when these muscles are shortened. In addition a small amount of bone burring can be done at the same time. Not that you know the correct procedure, the answer to your questions are as follows:
1) There is no risk to your brain or any major blood vessels or nerves.
2) There is no risk to your general health. This is an aesthetic operation.
3) This surgery does not affect the circulation to your scalp or head.
4) There is no risk of any hair loss.
5) The recovery is fairly quick, just some swelling on the sides of the head that looks pretty normal in a wee. There are no restrictions after surgery.
6) You could return to contact sports within two weeks after surgery.
7) I will have my assistant Camille pass along the cost of the surgery to you later today.
The biggest issue in performing temporalis reduction surgery is that fine line incisions are needed on the side of your head to perform it. These incisions do not cause any hair loss and I do not shave the incision line to perform them.
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 am interested in your temporal reduction procedure. My head is an unusual shape and size and increases in size above the the ears quite dramatically. Please see the pictures attached. Is there anything you can do to reduce he bulge and make it look more normal?
A: Temporal reduction is one of many head reshaping procedures to change abnormal contours. I can see from the pictures you sent that you have a very prominent bulge above your ears. This is caused mainly by the size and shape of the temporalis muscle. While many people think this is due to the shape of the bone, it is really mainly a muscle thickness shape issue. This can be dramatically changed and a near flat temporal profile above the ear achieved by temporalis muscle reduction. This is done through a small vertical incision above the ear. The prominent part of the muscle is released and removed.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in temporal reduction. (head width narrowing) Since I am a young child I haven had a serious problem with the shape of my head. It is almost totally flat at the back and bulges out quite a lot not just above my ears but at the whole temporal area, because of the permanently wrong sleeping position as a baby. Now I am 21 years old and my head width is 177-178 mm , while the average male human breadth is about 150-155mm (depends on ethnicity and height). I am 183 mm tall and in my whole family there is no such a case like me so that it is definitively no genetic reason for that excessive width. Furthermore there is an asymmetry as the right temporal region sticks out for about 3-4 mm more than the left side, so that when I haven’t long hair it can be seen. Now my two questions:
1) Is it possible to reduce the temporal region in order to make it more acceptable ?
2) How much would it cost as it is not just a small bulge but an area with about 40 to 50 square cm on each side? I have attached pictures of my head with line drawings so you can see what I am talking about.
A: Temporal reduction can be an effective head narrowing procedure in the properly selected patient. A bulging side of the head is made up of a combination of temporalis muscle and temporal bone. While many perceive that the problem is too much bone, the reality is that more than 50% of any temporal convexity is muscle. The smaller the amount of temporal convexity, the more that the attachment and thickness of the muscle is the problem. Your pictures show a mild to moderate temporal convexity (in my experience) which indicates to me that a muscle reduction/shortening would be an effective solution.
When it comes to temporal muscle reduction, there are two approaches…injectable Botox and surgical reduction. Botox injections can work for permanent reduction in the thickness of the muscle and has the advantage that it can work on any area of the muscle. Its disdvantage is that the result from its use take time, require multiple treatment sessions and may not work for everyone. Surgical reduction produces an instantaneous result by permanently and immediately removing a portion of the muscle. Its disadvantage is that it does require small vertical incision and can not reach all areas of the muscle.
When you look at your side diagram with your drawing, surgical reduction can reach the back half of that drawing but the thickness of the muscle at the edge of temporal hairline and in the non-hair bearing skin to the side of the eye is beyond what surgical muscle reduction can reach.
Based on your temporal areas of concern, you could either try a series of Botox injections or combine surgical reduction with Botox injections for the most forward part of the temporalis muscle.
Dr. Barry Eppley
Q: Dr. Eppley, I am quite determined to have temporal reduction surgery done (head width reduction), but there is still a couple of lingering question I need answered. I have attached several CT scans of my head to get a better visualization on the width of my muscle as well as my skull. I was born with positional plagiocephaly. This has caused my head to be misshaped and one side of my face is wider than the other side. Initially, I was thinking about getting the head width reduction for both side of my face, however, after a careful consideration I want to focus the head width reduction on just the right side of the face on the wider side. If the result of the reduction is significant, I might consider a reduction on the other side of face as well as jaw and chin bone reduction on the wider side of the face. One of my main concern of the reduction is how much the width can be reduced. I recently took a CT scan of my head and I found that the size of the temporalis muscle at the widest area of my head isn’t very thick being about 6mm. Thus I felt through only muscle reduction there might not be as significance of reduction compare to when if both muscle and bone reduction is performed at some region of my head. Also I recalled last time we talked that you told me that you are not gonna remove a lot of muscle you simply reattach it and let it shrink. Since the temporalis muscle at some of widest regions of my head is only 6mm, I felt the shrinkage of muscle won’t likely achieve my desire width of reduction which is between 5mm to 7mm on the right side. Thus, I wanted to see if I can completely remove the temporalis muscle on that side above the ear.
A: It appears you have misinterpreted how I do the temporal reduction surgery. I initially detach and remove the posterior muscle in its entirety, then detach the rest from the temporal crest, shorten it and reattach it lower. So the entire posterior muscle is removed. That is critical to get a very visible width reduction from 5 to 7mms based on the thickness of the muscle present. Bone reduction is done based on what the CT scan shows although it is never as significant usually as the muscle reduction, but it is an additive component to the overall width reduction. Certainly only one side can be done if desired and, in cases of asymmetry, met be the best initial approach.
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 have further questions in regards to Temporalis reduction please. The area I want reduced is around squama temporal and the parietal area near the temporal line. In anatomical images, the temporalis muscle shows up white in that region, so is there very little muscle mass there? Will Temporalis muscle show up on CT scans? Also, would the surgery involve having to sever my temporal arteries? If so, will there be side-effects later in life? As temporal concavity is dependent on muscle mass, is that why elderly people appear to have narrower temples due to muscle degeneration? If so, will temporalis reduction increase wrinkles around that area and make me look older? I know you said it won’t affect mastication processes, but would it impede speech and pronunciation, since it involves jaw movement too? Will temporal muscle reduction make me unable to play soccer or tennis for the rest of my life?
A: To answer your further questions on temporalis muscle reduction:
1) The muscle is thinner near the anterior temporal line.
2) The muscle will show up on a CT scan.
3) The superficial temporal artery is not cut during muscle reduction.
4) The fullness of the temporal region is prinicpally controlled by muscle mass and an underlying extension of the buccal fat pad. As people age the fat resorbs and the area becomes more concave. The temporalis muscle does not really atrophy with age.
5) Temporal muscle reduction will not affect chewing or speech.
6) I see no physical restriction after such surgeries for either tennis or soccer.
Dr. Barry Eppley
Q: Dr. Eppley, I had a serious head injury in 1994 that left me with a skull indentation on the right side of my upper forehead and it looks like I still have swelling in the temporal area. Would it be possible to flatten that temporal area and fill in the dent in my forehead to make my face symmetrical?
A: At this point nearly 20 years after your injury, I can assure you that the bulge or fullness in the temporal area is not swelling. It is either a perception of a bulge due to the forehead indentation or an alteration (uprising) of the temporal bone as the forehead area became indented. Regardless, I am certain both areas are improveable at the same time. I would need to see some pictures to get an idea of the magnitude of the problem and see exactly what needs to be done. The forehead indentation can be filled in with bone cement (frontal cranioplasty) to match the other side as best as possible and the temporal bone or muscle can also be reduced if needed.
Dr. Barry Eppley
Q: Dr. Eppley, I have wide temporal areas between the sides of my eyes and my hairline that I want reduced. Is the temporalis muscle the reason why some people have bulged temples that are wider than their cheekbones, and some with troughed temples as wide as, or narrower than their cheekbones? Or has it also got something to do with the cranium itself? Is this feature genetic at all? My mother has troughed temples that are slightly narrower than her cheekbones, and my dad has bulged temples wider than his cheekbones. So have I carried my father’s genes for that particular feature? Thank you.
A: The shape of the temporal region, whether it is a convexity or a concavity, is largely controlled by the thickness of the temporalis muscle mass, not bone. Only very rarely, in cases of a temporal bone tumor, is a temporal convexity driven by the size of the bone. This feature appears to be completely genetically derived.
Dr. Barry Eppley