Temporal Artery Ligation

Q: Dr. Eppley, I’m a plastic surgeon and I did some internet search on options for treating prominent temporal artery and I came across your opinions and website. I have chatted with a few of my colleagues and seniors and nobody seems to have experience with this ! Have you had success in treating the prominence with temporal artery ligation? I have a bald male patient who is very bothered by the prominence and is looking at surgical options. I would totally appreciate it if you would give me your opinion on the temporal artery ligation procedure.

A: This is a procedure that I have done many times and with good success. It is not, however, performed as has been historically done for temporal artery ligation for temporal arteritis or for temporal artery biopsies. It requires careful tracking of the arterial branches with multiple ligation points to prevent back flow and to get any feeders coming into the main anterior branch of the superficial temporal artery. The other key element of the procedure is that the incisions must not exceed 5mms in size and requires loupe magnification and head light to meticulously work through such small incisions and tie off the small arterial branches. One must also be prepared to venture out into the forehead to get the distal branches and do careful dissections to avoid the frontal branch of the facial nerve.

While not every case of multiple point temporal artery ligation will result in complete elimination of the prominent vessel, it always results in significant reduction in their visibility.

Dr. Barry Eppley

Indianapolis, Indiana