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Dr. Barry Eppley

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Posts Tagged ‘head widening implants’

Technical Strategies – Head Widening Implants

Monday, February 15th, 2016


The width of the side of the head  is controlled by the shape of the temporal bone and the thickness of the temporalis muscle, all located above the ear. While many think the bone is the main contributing factor, the thickness of the temporalis muscle should not be underestimated. By CT scan measurements it can be seen that the temporalis muscle usually makes a bigger contribution than that of the bone to the width of the side of the heasd.

Regardless of the anatomic makeup of the width of the head, widening the narrow head must be done by either onlay augmentation of the bone (submuscular) or onlay augmentation of the muscle. (subfascial) Which implant location is best depends on whether the augmentation involve just the posterior temporal region (above the ears) or also the anterior temporal region as well. (by the side of the eye)

Head Widening Implants (anterior and posterior temporal implants Dr Barry Eppley IndianapolisHead Widening Implants (incision and subfascial dissection) Dr Barry Eppley IndianapolisMost head widening implants augmentation include both the anterior and posterior temporal regions. This can be accessed through a single 4cm incision placed in an intermediate location in the temporal hairline. Using a subfascial incision and pocket dissection, extended anterior and larger posterior temporal implants can be placed through the same point of temporal incisional access.

Head Widening Implants (implant placement and subafscial closure) Dr Barry Eppley IndianapolisHead Widening Implants (incision closure) Dr Barry Eppley IndianapolisAfter the placement of both anterior and posterior temporal implants in the subfascial pockets, the fascia os closed over the them. The skin closure is done in a two layer fashion with resorbable sutures.

Head widening or complete temporal augmentation can be done through a single small temporal incision. Two implants are needed to increase the volume of both the anterior and posterior temporal regions.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Posterior Temporal Implants for A Head Widening Effect

Thursday, July 9th, 2015


Background: The shape of the head has many aesthetic components to it not unlike that of the face. While no area of the head as the degree of aesthetic complexity that the face does, that does not mean that cosmetic concerns about specific areas of the head do not exist. They are less well known and treatments for them are even more obscure but public perception is increasing. The popularity of shorter haircuts and men shaving their head has given rise to an increased awareness of head shape concerns.

One aesthetic area of the shape of the head that is rarely discussed from a diagnosis or treatment corner is that of its width. The width of the head is created by the sides of the head which run from the superior attachment of the ear up to the temporal line of the skull. This area lies within the hair bearing area of the broader temporal region and is only composed of muscle (and fascia) and bone. While many think its shape is largely caused by the shape of the temporal bone, the reality is that the temporal muscle makes a greater contribution to its thickness than that of the bone.

Head Width Dr Barry EppleyWhile there are no truly established aesthetic standards for the sides of the head, some general guidelines can be used. A straight line or flat side of the head would be viewed by most as being too narrow. Conversely a significant arc or amount of convexity would be thought of as being too wide. It appears that a slight amount of temporal convexity is the most aesthetic shape when viewed from the front.

Case Study: This 35 year-old male had an underlying congenital skull deformity (most likely occipital plagiocephaly) which has been previously treated by occipital and anterior temporal augmentation. His lone remaining head shape issue was that he felt the very sides of his head were too narrow, more so on the right side than that of the left.

Posterior Temporal (Head Widening) Implants intraop placement Dr Barry Eppley IndianapolisHead Widening (posterior Temporal ) Implants result Dr Barry Eppley IndianapolisUnder general anesthesia, performed posterior temporal implants were placed in a subfascial location on top of the posterior belly of the temporalis muscle. A small vertical incision in the hairline was used since he already had an existing scar there from prior surgery. The thickness of the preformed posterior temporal implants was 4mms. A good fascial closure as obtained over the implants prior to closing the skin.

His postoperative results showed a noticeable but not overdone head widening effect.  The slight increase in temporal convexity gave his head a more pleasing shape with the noticeable fullness. He had no discomfort or restriction in opening his mouth after surgery as has been my experience with all subfascial temporal implants at either the anterior or temporal location.


1) The aesthetics of the side of the head generally have some degree of convexity or can appear as too narrow.

2) Subfascial posterior temporal implants can be placed to create an increased amount of head widening.

3) Generally 4 to 7mms of head width is all that is needed on each side to create a very noticeable difference.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Postauricular Approach for Head Widening Implants

Thursday, May 21st, 2015


Augmentation of the face through a variety of implants has been around for along time. Implant augmentation above the face on the skull bones is almost unheard of. Skull augmentations are much less commonly done, not only because they are less frequently requested, but because they are no implants made for them and surgical techniques taught to do them.

Some people have abnornally narrow skull shapes with the temporal region above the ears (what I call the posterior temporal zone) being non-convex. The typical aesthetics of the posterior temporal zone is to have some convexity due to the shape of the bone and the thickness of the muscle. When the temporalis muscle is thin or the shape of the posterior temporal bone is more linear than convex, the side of the head can look very narrow. This becomes most manifest in men with short cropped hair or who shave their heads. Although I have seen patients who have substantial hair cover who are equally bothered by it.

A head widening or posterior temporal implant is a very effective implant augmentation of this area. The implant can be placed either in the subfascial or submuscular location depending upon the incisional access. A vertical incision directly in the side of the head provides direct and easy access to subfascial placement of the implant. However such an incisional approach introduces potential scar concerns particularly with little to no hair color.

Head Widenng Implant Surgical Technique Dr Barry Eppley IndianapolisHead Widening (Temporal) Implants Surgical Technique Incision and Pocket Dissection Dr Barry Eppley IndianapolisA postauricular approach is the ‘scarless‘ method for a head widening implant. With an incision in the crease of the back of the ear a submuscular pocket can be easily created. The pocket can be made from the very back of the posterior temporal region anteriorly to the front edge of the hair bearing temporal scalp. (anterior temporal zone) A posterior temporal implant can seem too large to fit through this small incision but the flexibility of a low durometer silicone implant makes it possible.

Head Widening (Temporal) Implants Surgical Technique Implant Placement Dr Barry Eppley IndianapolisThe posterior temporal implant must be folded onto itself, inserted and then unfolded once in the submuscular pocket. The pocket is fairly tight and the size of the implant makes it very unlikely that implant migration or displacement can occur. But I usually still place a single small titanium screw into the bottom of the implant for absolute security. It is critically important the closure of the postauricular approach re-estsblishes the muscle and fascia layers so the ear do not become protruding due to loss of its posterior attachments.

Posterior or head widening temporal implants can be placed through a postauricular incision into a submuscuar pocket. The implant usually does not need to be greater than 5mm to 7mms to great a substantial head width change when done on both sides of the head.

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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