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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Case Study – Head Narrowing by Posterior Temporal Muscle Reduction


Background: The shape of the head is influenced by five different surfaces. These consist of the front, back, sides (2) and the top. Each surface has an effect on the appearance of the overall head shape. While there is specific numerical numbers that define the ideal head shape, there are certain convexities and shapes to it that make it either appealing or unaesthetic.

The shape of the side of the head is rarely thought unless it has some abnormal shape to it. The side of the head, also known as the posterior temporal region, can be seen as unaesthetic if it is too wide (increased convexity) or is too narrow. (no convexity) By far the more common concern is one of too much convexity which creates the ‘lightbulb’ appearance. This is where it is wide high above the ear and then becomes more narrow as it gets closer to the ear.

The posterior temporal region is composed of five layers. These consists of the skin, subcutaneous fat, fascia, temporal muscle and bone. While all layers make a contribution to its thickness, the muscle represents a more significant component than most think.

Case Study: This 36 year-old male was bothered by the very wide sides of his head. He had short hair and his head width was visibly disproportionate to the rest off his head and face. A posterior temporal muscle resection was planned to narrow the sides of his head whose outline was drawn on before surgery. He did not find a low temporal incision unacceptable so the incision was made beyond the sulcus of the back of the ear. (in most cases of posterior temporal reduction the incision is kept completely behind the ear)

Under general anesthesia the entire posterior temporal muscle was removed in a subfascial manner for a head narrowing effect. The anterior border of the resection was made along an oblique line from the top of the ear superiorly up to the anterior temporal line. The size of the muscle was exceptionally thick.

The narrowing effect of the muscle removal was immediately evident as would be expected with a muscle thickness of 7mm to 9mms.

Head narrowing is done by muscle removal and not bone removal. There are no functional deficits created by removal of the entire posterior temporal muscle. (limitation of jaw motion or even creation of jaw stiffness)


  1. The posterior temporal muscle makes up a significant thickness of the side of the head.
  2. An overly convex side of the head can be reduced by posterior temporal muscle excision.
  3. Side of the head reduction (head narrowing) can be done in most cases by a hidden incision behind the ear.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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