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Posts Tagged ‘head widening’

Total Head Widening with Anterior and Temporal Implants

Saturday, May 30th, 2015

 

Temporal Regions of the Head Dr Barry Eppley IndianapolisThe sides of the head, known as the temporal regions, is made up of the overlying temporalis muscle and the underlying temporal bone of the skull. What separates the temporal region on the visible outside is hair. The temporal hairline stops before reaching the side of the orbit leaving a strip of skin that runs from the zygomatic arch up to the forehead. This is an area that can develop the most visible temporal hollowing, is usually referred to when talking about the temples, but is what I call the anterior temporal region. Any part of the temporal region that lies in the hair bearing area is known as the posterior temporal region and extends back to behind the ear.

Anterior and Posterior Temporal Implants for Head Widening Dr Barry Eppley IndianapolisWhen desiring to augment or widen the side of the head, a comprehensive approach is needed to augment both the anterior and posterior temporal regions. This requires two separate temporal implants, one for each region which have different shapes. The anterior temporal implant is more high than wide. The posterior temporal implant is more oval shaped and is wider than it is high. They can be placed through the same vertical incision whose length is no more than 4 cms.

Anterior and Posterior Temporal Implants for Head Widening Placement Technique Dr Barry Eppley IndianapolisAnterior and Posterior Temporal Implants for Total Head Widening Surgical Technique Dr Barry Eppley IndianapolisSubfascial placement of the anterior and temporal implants is done through the same incision. This is a simple dissection that does not disrupt or injury the temporalis muscle. Dissection of the anterior temporal region needs to extend superiorly to the anterior temporal line at the side of the forehead, down along the lateral orbital rim and inferiorly along the zygomatic arch. Dissection of the posterior temporal region must be carried over the entire extent of the posterior belly of the temporalis muscle, up to the temporal line, posteriorly to the occiput and inferiorly above the ear.

The temporal implants are easily slide into place and the fascia can be closed over the posterior end of the anterior implant and the anterior end of the posterior implant. Closing of the fascia is not mandatory, and is what will cause some temporary postoperative stiffness on oral opening, but creating a tissue layer between the implant and the skin always seems like a good idea.

Total widening of the head can be done using subfascial anterior and posterior temporal implants. They are straightforward to place and do not cause any undue amount of swelling or prolonged postoperative recovery. Typically most patients will look fairly normal in  7 to 10 days after the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Temporal Implants for Head Widening

Friday, February 21st, 2014

 

Background: The head has a wide variety of shapes and sizes. Like the face, there are  certain head shapes that are more pleasing than others. While one knows intuitively whether they like their head shape or not, there are certain measurements of height and width of the head that can help classify its beauty or conversely its degree of deformity.

Head Measurements Dr Barry Eppley IndianapolisHead and face measurements and their ratios have been studied for over 100 years in a field of scientific study known as anthropometry. Classic anthropometric measurements of the head are its length, width and cephalic index. The length of the head (front to back) is measured from the midpoint of the brow just above the nose back to maximal projecting point of the back of the head. The width of the head is from a point just above the ears from one side to the other. Taken together the cephalic index is derived which is obtained by taking dividing the width of the head by its length which creates a percent ratio. This number is almost always less than 1 since most normal human skulls are longer than they are wide. Based on their cephalic index, head shapes have been historically divided into three main types; long-headed (dolichocephalic, > 80%), medium-headed (mesocephalic, 75% to 80%) and round-headed (brachycephalic, < 80%)

The dolichocpehalic head is one that has a narrow head width. (which is compensated for by an increased head length) But there are certain head shapes that are narrow in their bitemporal width but do not have an increased cranial length. Their mid-temporal region slants inward as it ascends upward to the top of the skull rather than having a more aesthetically pleasing convex shape on the side of the head.

To date, there has not been any known method to safely and easily create aesthetic augmentation for increasing the width of one’s head should their bitemporal width be too narrow.

Case Study: This 35 year-old young man did not like the narrow width of his head. He felt his head was too narrow above the ears and it slanted inward rather than outward. This made his head ‘too small’ and disproportionate for the rest of his head and face shape. He wanted a wider head but did not want any visible scars in doing so given his close cropped hair.

Custom Temporal Implants for Head Widening Dr Barry Eppley IndianapolisWhile a 3D CT scan would have been ideal to make his custom temporal implants, he wanted to forego that extra expense. Using a standard male skull model, implant designs were done in silicone elastomer putty by hand with dimensions of 10 cms long, 8cms high and 7mms thick at its central location. The edges were made paper thin to have a smooth implant transition. The handmade temporal implants were converted into a medium durometer medical grade silicone implant and sterilized.

temporal implant size dr barry eppley indianapolisTemporal Widening Implants Surgical Placement Dr Barry Eppley IndianapolisUnder general anesthesia, skin incisions were made on the back of the ear in the depth of the postauricular sulcus. Dissection was carried down to the fascia and then superiorly under the lower edge of the temporalis muscle. Wide submuscular elevation was done over markings for the implant location that were made prior to surgery. The temporal implants were then rolled and inserted through the small incision and all edges unrolled once inside. The implants were then secured to the underlying bone at its lower edge with two 1.5mm titanium screws. The incision were closed in multiple layers, re-establishing the postauricular sulcus by dermal sutures to the fascia.

While he had some moderate temporal swelling after surgery, his pain was minimal. He had little recovery other than some swelling that resolved in a few weeks. His head width was instantly changed into a more convex shape which was very pleasing, adding 1.5 cms of bitemporal width. (Due to patient privacy, he did not want his before and after pictures published online. However he is willing to have them sent to anyone that wants to view them privately. You can request his before and afters by contacting me at info@eppleyplasticsurgery.com)

This type of temporal implants provide increased width and convexity for the narrow head. While custom temporal implants can be made from a  patient’s 3D CT scan, the relative flat bony surface of the mid- and posterior temporal region makes a semi-custom approach a good treatment option. This new type of skull implant design provides another option in skull reshaping/augmentation that provides a different type of temporal augmentation that smaller more anterior-based implants for the non-hair bearing temporal hollow.

Case Highlights:

1) A narrow head is usually due to a bitemporal width reduction of the skull and/or muscle.

2) Custom temporal implants can be made to increase the bitemporal width from 5mm to 7mms per side.

3) Large custom temporal implants can be discretely placed through incisions on the back of the ears.

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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