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Temporal artery ligation is a procedure used to reduce the appearance of the visible pathway of the superficial temporal artery onto the forehead. Often described by patients as ‘worms’ or ‘prominent veins’ they are largely an aesthetic male facial concern. While their appearance may be evident normally, they become enlarged when exposed to sunlight, increased heart rates (exercise) and with the consumption of alcohol. This is a testament to their arterial origin as the vessels dilate due to smooth muscle relaxation and/or increased blood flow.

Reduction or elimination of their appearance is done by a multi-point ligation technique. At select branching points of the anterior branch of the superficial temporal artery, the artery is tied off to eliminate both forward and back flow into the vessels. This almost always creates a reduction in the size of the vessel which thus reduces its appearance. About 25% of patients will develop some branch recurrence from a feeding vessel that was not seen during the initial procedure that may require a secondary ligation.

Such multi-point ligations do require small skin incisions, many of which are located on the visible temporal and forehead skin. While the incisions are small (5mms) and are often placed at horizontal forehead wrinkle lines, patients are understandably concerned about scarring. In over 50 temporal ligation sides with near 200 ligation incisions I have yet to have a patient request a scar revision or be concerned about the appearance of any of the ligation skin incisions. This is a testament to their small size and good placement location.

Temporal ligation is an effective procedure that results in no adverse aesthetic scar issues. Despite the lack of scarring the goal of the procedure is still to have the least amount of ligation points that will still effective reduce or eliminate the appearance of the temporal arteries.

Dr. Barry Eppley

Indianapolis, Indiana

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