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A not uncommon esthetic abnormality of the temporal region are prominent arteries. Unlike temporal veins which will have a bluish hue and run in a relatively straight vertical, the superficial branch of the temporal artery has a classic serpiginous course as it proceeds superiorly from the temporal hairline and crosses into the side of the forehead. For some so affected by their visibility they can be surgically reduced in appearance through a multilevel ligation technique.

Having ligated many prominent temporal arteries I can male three observations, not all of whom can be fully explained. The first is that they generally occur in thin patients who are often athletic. This of course is not surprising as they have aa very limited subcutaneous fat layer which would make the artery as it leaves the hairline more visible. The second observation is that the artery has a highly tortuous course and is far from a straight-line vessel. While in anatomy ‘form follows function’ is a guiding principle the purpose of such an irregular course is not evident. It has no branches along its course so its purpose is not to improve the blood supply to adjoining tissues along the way.

The third observation is that prominent temporal arteries are much more common in men. This does not mean they do not occur in women just much less frequently. This is probably due to two reasons. Men have larger arteries with thicker muscle layers making them prone to increased enlargement. In addition men topically have less hair to cover the forehead and temporal areas which makes their appearance more visible and perhaps less tolerable.

But when they occur in women they are not treated any differently than in men. It still requires a multi-level ligation technique. It generally takes three ligation points at a minimum and often one or two more are needed. Most of the ligation points are right at the temporal hairline in an ascending fashion. The one ligation point that is exposed is at the lateral forehead where the artery turns and goes more vertical up into the frontal hairline.

While scars from aesthetic temporal ligations have never been a concern even in shaved head males they are even less so in females because they always have a hairline in which to place them.     

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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