Q: Dr. Eppley, I am going to surgically contour my facial bones, specifically from the zygoma and below. Unfortunately, where I am going they do not do temporal reduction bone surgery. So in order to achieve the look I am going for, long and thin, I was wondering, to what extent may the sides of my head be reduced without removing a lot of muscle, mainly temporal bone?
A: Contrary to popular perception, temporal reduction is done by removal of muscle not bone. The fullness of convexity of the head above the ears is a combnation of bone and muscle but the ratio is weighted more towards the muscle and not bone. The thickness of the posterior temporal muscle in men can be anywhere from 7 to 1 mm thick. In contrast the thickness of the bone may be only 3 to 5mm thick. You can demonstrate this by getting a CT scan to see the tissue makeup on the side of your head.
To really make a difference in temporal reduction surgery, you remove the entirety of the posterior temporal muscle not burring the bone. Bone reduction will make little if any difference in its width, muscle removal can make it completely flat. Interestingly, removal of the posterior muscle has no long-term effects on mouth opening as the much larger anterior portion of the temporal muscle remains.
Dr. Barry Eppley