Temporal implants offer a permanent and effective augmentation method for unaesthetic temporal hollowing. They are usually inserted from the side into a subfascial pocket through small vertical skin incisions in the temporal hairline. While this incisional approach usually heals quite well, its use in the male patient who shaves his head or has a close haircut along the sides of his head must be considered with caution.
An alternative insertion approach for temporal implants is from a superior point of access. Coming from a northern point in the scalp is also a useful approach. A superior-inferior dissection direction actually offers an easier method off implant placement, particularly for the extended temporal implant style.
The most convenient time to use a superior approach is when the scalp area is already open from another procedure. Such procedures would be brow bone reductions, brow lifts, hairlines advancements and any form of forehead bone reductions. From these approaches the temporalis fascia is seen coming right up to the bony forehead. A horizontal incision can be made in the fascia through which a pocket can be dissected on top of the muscle down to the zygomatic arch. The width of the incisional opening allows for the implant to be placed in its correct vertical orientation.
Getting to the temporalis fascia can be done from a variety of directions. The lateral incision in the temporal hairline provides the most shortest route. The superior scalp incision pzrovides the best orientation for implant placement. The postauricular approach provides a scarless approach but the most challenging for subfascial pocket distance and for implant orientation. All incisional methods for placement of temporal implants work, and I have used them all, but the superior approach is a natural option the forehead is already open for other procedures.
Dr. Barry Eppley
Indianapolis, Indiana