Facial implants are commonly used to augment various areas of the face. While historically this had been relegated to the cheeks and chin, their use has been widely extended to many other facial areas as well. One of the newer areas of facial implant use has been the temporal region for correction of excessive temporal hollowing or concavity.
Temporal implants are uniquely different from almost all other facial implants because they do not augment bone. Rather they are soft tissue implants that augment the amount of muscle volume that exists in the temporal region. What causes temporal hollowing is loss of fat volume and/or muscle, not a change in bone volume. While augmenting the anterior aspect of the temporal bone can be done, it would require a large implant placed very deep under the muscle to create that effect. It is far simpler and more effective to place a smaller implant right under the fascia on top of the muscle which is how newer temporal implants are done today.
Traditional temporal hollowing involves the lower half of non-hair bearing aspect of the temporal region just to the side of the eye. (lateral orbit) This is referred to as the Zone 1 temporal region. But other temporal areas can be augmented as well for different aesthetic effects. One of these is the Zone 2 temporal region. This is the upper half of the non-hair bearing area (above Zone 1) which is more to the side of the forehead than it is the eye. It abuts right up against the anterior temporal line of the forehead. Thus augmenting the temporal zone 2 creates a forehead widening effect.
Zone 2 temporal implants, like Zone 1, are placed under the fascia from a small incision in the temporal scalp area. While they are subfascial, the temporalis muscle gets very thin as it approaches the forehead. In addition, the underlying temporal bone no longer is concave but starts to become almost convex as it merges into the forehead. Thus a Zone 2 temporal implant is closer to being a bony augmentation technique rather than a purely muscle implant like Zone 1.
Widening the forehead has been traditionally very difficult. Extending bone cements from a forehead augmentation onto the temporalis fascia can result in a visible line of the material and discomfort. Fat injections can be done but their survival and smoothness if far from assured. Custom silicone implants can be made for forehead augmentation that extends onto the temporalis fascia to both augment projection and width of the forehead. But for those patients that just want a little more forehead widening only, there have been no options to date.
Zone 2 temporal or forehead widening implants offer s a simple and effective solution to those patients that would like to see just a slight increase in their horizontal forehead width. By placing an implant just to the side of the anterior temporal line under the fascia, the forehead can be made wider in appearance. This procedure, like Zone 1 temporal implants, has a very rapid recovery with little swelling and discomfort afterwards.
Dr. Barry Eppley
Indianapolis, Indiana