Q: Dr. Eppley, I was curious how your temporal reduction procedure is done. Do you remove the whole portion of the muscle directly in front of and behind the ear or do you reduce the depth/thickness of the muscle? I have attached a picture that shows what I am talking about specifically. If you do remove the whole portion of the muscle, then what happens if the muscle was too thick and then there is now a visible transitions into the anterior portion of the muscle. I’m worried that it might look odd. What are your thoughts?
A: Thank you for your inquiry about posterior temporal reduction. You are correct in that this is a muscular reduction procedure to decrease head width above the ears. Your attached diagram shows very precisely the location of the muscle removal. I could not have drawn it any better myself. It is not really possible to remove just a portion of the muscle and, even if you could, you would not want to. To make a visible head width narrowing it requires the entire thickness of the muscle to be reduced which is usually 5 to 7mms. (or more in some patients) Your concern about having an uneven edge to the back part of the anterior temporalis muscle (a step-off) is a valid one and a finding I have observed every time I do the procedure. But it is a self-solving problem as the muscle edge shrinks down and becomes more feather edged as it heals. (muscles shrink and contract when injured) This is also helped by using electrocautery at the muscle edge to induce it to shrink as well as the entire temporal reduction procedure is done in the subfascial plane. The tight overlying fascial layer acts to push the muscle down and obscures this temporary step-off as it heals.
Dr. Barry Eppley