Q: Dr. Eppley, I am a 24 year-old guy looking out for skull reduction surgery. I have very wide skull especially above ears, also muscle over the portion is so hard and overdeveloped it is creating very absurd symmetry. I don’t want to have Botox reduction as it is temporary solution hence looking for permanent solution through reduction surgery. Can you please tell me is it possible to reduced muscle to large extent? Also I want skull side to be reduced to some extent. I am looking for narrow skull with vertical indentation. I feel very upset and depressed because of this. Please advise me as soon as possible. Really looking forward for your help.
A: You are correct in assuming that the full area above your ears is as much temporalis muscle as it is bone. Temporal bones are often quite thin so even though they may protrude they can not be reduced very much, usually no more than a few millimeters Muscle reduction is the primary tissue to reduce for narrowing/thinning. Reducing the temporalis muscle is a combination of muscle release and muscle resection. The temporalis muscle is a very large fan-shaped muscle that extends from above the zygomatic arch up to thue anterior temporal line at the top of the skull as well as back to the occipital region. To do temporalis muscle reduction, the enture muscle is released from its origins for the lateral orbit up and across the skull. A central wedge of kmuscle is then taken. Much of the reduction ultimately comes from the contraction and atrophy of the muscle which can take up to six months after surgery to be fully realized. Because it is a muscle of mastication and inserts into the lower jaw, expect some temporart restriction and soreness with mouth opening after surgery.
Dr. Barry Eppley