Q: Dr. Eppley, I have very large temporal muscles that I want reduced. They stick out significantly from the side of my head. It is not normal to look like this with such bulges. What is involved in reducing the temporal muscles. I have attached some pictures for you to see what I mean when I say these muscles are big. They might be great if they were biceps on my arms but not the side of my head!
A: Thank you for sending your pictures. That is one of the larger temporalis muscle hypertrophies that I have seen given the muscle size and the shape of the surrounding skull and orbital bones. It is no doubt all muscle and not caused by enlargement of the underlying temporal skull bone. You can confirm that by clenching your jaws and seeing the muscle striations and how much it bulges.
To reduce a temporalis muscle that is this large, a central wedge resection of the muscle must be done. This is accomplished through a vertical incision in the hairline on each side. The temporalis muscle fascia is opened and electrocautery is used to cut a large vertical wedge of muscle that parallels the muscle fibers out. The fascia is then reclosed. This will produce some immediate reduction in its size, not withstanding the temporary muscle swelling that will ensure right after surgery, but further reduction occurs up to six months after surgery as the muscle undergoes further atrophy. This is an outpatient procedure done under general anesthesia. Other than some temporal swelling and some stiffness on wide jaw opening, there is no significant recovery or restrictions after surgery.
Dr. Barry Eppley