Q: Dr. Eppley, I practice plastic surgery in Chicago. I attended a cadaver course on facial implants last year in Las Vegas where you gave a superb number of lectures on a variety of facial implant procedures. I have a question regarding temporal implants and which tissue plane to place it in, I can not remember exactly what you said. From what I remember, it was placed under the superficial layer of the deep temporal fascia (on the temporalis muscle). Is that correct? Also, what would be the reason to not place it on the fascia? Thank you for your time.
A: Temporal implants should always be placed in the subfascial tissue location. (under the deep temporal fascia and on top of the temporalis muscle. Temporal implants should NEVER be placed above the fascia. Placing temporal implants in this area is what has caused them to be described as a bad procedure due to complications. When temporal implants are placed above the fascia the outline of the implant will be seen when the swelling goes down…not to mention the potential risk of injury to the frontal branch of the facial nerve in placing it in this more superficial tissue plane.
Dr. Barry Eppley