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Reduction of the wide head is a procedure primarily performed by removal of the posterior temporal muscle. (temporal reduction) Besides the fact that few patients and surgeons even know such an aesthetic operation can be performed or exists, it is common that those who discover it grapple with why it works or have concerns about potential adverse functional facial effects. From that perspective let me address five concepts about temporal reduction surgery.

The Width of the Posterior Temporal Muscle Is Bigger Than One Thinks. The thickness of the side of the head above the ears is composed of three main tissues; skin, muscle and bone. While the temporal bone does make a major influence on side of head convexity, the posterior temporal muscle can often make up 40% to 50% of its thickness as well. In many male patients I have seen the muscle be 7mm to 9mm in thickness per side.

A Vertical Line from the Top of the Ear is the Excision Boundary. The anterior extent of the posterior muscle removal is determined by this line. Albeit somewhat arbitrary as there is more real defined transition between its anterior and posterior bellies, it is were the muscle starts to become much thicker. It is also a convenient point of access from the postauricular sulcus incision placed behind the ear.

Removal of the Posterior Temporal Muscle Causes No Jaw Dysfunction. Seemingly defying the purpose of its very existence, no long or even short-term jaw dysfunction has ever been encountered. If the patient opens their mouth really wide in the first day or two they may feel so tightenness/discomfort but this quickly passes. Undoubtably this occurs because the much larger anterior muscle belly remains (it makes up 70% of the overall temporal muscle mass) and the posterior belly makes an adjunctive but not essential contribution to jaw movements.

The Overlying Fascia of the Posterior Temporal Muscle is Preserved. Keeping the tight overlying fascia allows it to have a contouring effect. Initially the cut edge of the muscle will have a palpable step-off. The overlying fascia has a dampening effect on the remaining muscle edge and acts as a barrier to prevent skin adhesion directly to the now exposed bone. Its preservation also maintains the overlying vascular pedicle of the posterior branch of the superficial temporal artery.

Posterior Temporal Muscle Removal Takes Six Weeks To See Its Final Result. The dressing applied right after surgery is removed the following day. At its removal the flattening result is immediately apparent and usually satisfying. But then the swelling sets ion and it will be another 6 to 8 weeks before the initial result seen recurs.

Dr. Barry Eppley

Indianapolis, Indiana

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