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The desire for head widening can have several different meanings/objectives. It may refer to a widening of the side of the head that excludes that of the forehead, accurately described as temporal head widening. The other form of head widening is where it includes the side of the forehead and often the back end of the posterior temporal region (the equivalent of the side of the forehead on the back of the head) and would be called fronto-temporal head widening.

Fronto-temporal head widening uses custom implant designs to effectively treat the underlying problem which is a narrow or ‘pinched skull shape’ as seen in the frontal view. The head is narrow from front to back and lacks well developed bony temporal lines. Such skull reshaping implants are placed primarily through postauricular incisions in the crease of the back of the ear. A few very small secondary incisions are needed in the scalp to aid placement as well as to place screw fixation. (triangulated implant placement and fixation) The key to the tissue pocket of placement is that is must be on the top of the deep temporal fascia since it needs to cross over the bony temporal line of the forehead.

The fronto-temporal implant is remarkably effective and to date all patients have been pleased with this unique type of head reshaping surgery. One of the very pleased patients decided that the squareness of the forehead at the sides created by the implant was a bit too strong. He desired a slightly less square forehead shape AND some increased projection across the forehead. This required some modifications of the existing fronto-temporal implant design as well as the creation of a new forehead implant which was to lay across the forehead down to the brow bones and cover the most medial edges of the fronto-temporal  implants. (previous implants in green, new implant designs in teal and dark blue colors)

Placement of these three skull implants with remote incisions poses unique challenges. On the one hand, much of the tissue pockets needed for the new implants already existed. The lone exception is the new forehead piece which was placed through a new 2.5cm scalp incision behind the frontal hairline. But getting a precise alignment of the forehead piece over the medial edges of the fronto-temporal implants is unforgiving on the exposed forehead surfaces. Any slight misalignment of the three pieces will end up showing visible edges.  Fortunately a completely smooth forehead result was obtained. 

Dr. Barry Eppley

Indianapolis, Indiana

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