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Background: The temples are commonly recognized as the head/facial area that lies at the side of the eye just below the forehead. Anatomically at the skull level the temples is the juncture of four bones, the frontal, temporal, parietal and sphenoid. This joined bony areas create a deep concavity, known as the temporal fossa, which is covered by the thick temporalis muscle. 

The shape of the external temples is highly influenced by the thickness of the soft tissues that occupy the fossa, mainly the muscle but there is also a fatty component as well. Since the temples are not a bone based area there are no known measurements that determine what is aesthetically acceptable or unacceptable. It has a more of a contour shape to it with it either having a smooth contour (as determined by a straight line from the bony temporal line of the forehead down across the zygomatic arch) or a slight concavity to it. Women almost always have the latter while some men have the former. A convex shape to the temples is seen as an undesired bulge.

The one aesthetic concept that is for certain in temporal aesthetics is an excessively deep concavity, due to either aging or disease, creates an unhealthy appearance. What is it often not appreciated is that a fuller temporal region can be associated with a stronger masculine appearance. Like the appearance of a wider jaw angle in the lower face, the thickness of the upper temporal muscle can have a similar masculinization effect.   

Case Study: This male with a more juvenile looking face was going to undergo a major jawline augmentation with a custom jawline implant. At the same time he wanted a fuller temporal appearance as well. Along with his custom jawline implant, custom temporal implants were designed as well. The temporal implants covered a large surface area but only needed to be 3mm thick at most.

Under general anesthesia and through a 3 cm long vertical temporal incision back in the hairline was made on each side. A subfascial pocket on top of the temporalis muscle was developed.  The implants were inserted in a rolled fashion, unrolled and then positioned as per the design. Fascial and skin closure was then done. The custom jawline implant was done immediately after.

Male temporal augmentation usually has a different intent than in women. In women they are usually correcting a significant hollowing which makes them look older. Men may also undergo the procedure for hollowing, often due to atrophy from disease, but may seek a larger augmentation effect to create a broader forehead appearance. This is the masculinization effect of temporal augmentation in which the implant is really designed to be a forehead ‘extender’ back along the side of the head. 

Case Highlights:

1) Temporal augmentation can be done as a part of facial masculinization effort.

2) Wider temples contribute to the appearance of a broader forehead. (forehead widening)

3) Custom temporal implants can widen the entire non-hair bearing temporal region back into the hairline.

Dr. Barry Eppley

Indianapolis, Indiana

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