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Background: The face is well known to be divided into aesthetic thirds. This aesthetic concept is important in both frontal and side views but with different dimensional effects. A lesser appreciated proportional measurement is that of facial fifths in the frontal view which relates to various transverse and vertical relationships.  From this perspective the outer facial fifth is a vertical line which establishes how the side of the head (temporal) relates to that of the width of the jaw angles.

In men that augment their jawline or jaw angles with implants (lower facial third), they may find after such surgery that what lies above may end out of proportion. This is partially addressed by cheek-arch augmentation which adds width to the midface but then the side of the head above that appear oo narrow. This is a unique phenomenon that is the direct result of custom facial implants where the face can be significantly changed in numerous dimensions. I have seen this in numerous male patients who may chase improved facial proportions from the ‘bottom up’ after a custom jawline implant augmentation.

When the side of the head is too narrow compared to the lower face, there has not been historically any treatment for it. But that has changed with the introduction of standard temporal implants for the anterior region by the side of the eye and the use of custom temporal implants for the side the head above the ears. When done together or in two separate stages the entire side of the head from front to back can be widened.

Case Study:  This young male had a prior history of a custom facial implant placements consisting of chin, jaw angles and infraorbital-malar areas. While this provided major facial reshaping improvements he felt he now lacked sufficient width at the sides of his head. Custom temporal implants were designed to augment the entire side of the head extending over the anterior and temporal areas. (convex and concave parts of the temporal bone.

Under general anesthesia and through superior postauricular incisions, a submuscular pocket was developed under the entire muscle. The implants were then placed and positioned. A small drain was placed under them to be removed the following morning.

Custom Temporal Implants Dr Barry Eppley IndianapolisThe perception of the width of the side of the head is influenced by two anatomic areas. This includes the non-hair bearing anterior temporal area by the side of the eyes as well as the larger hair bearing areas back along the side of the head above the ears. (posterior temporal area) While standard temporal implants exist for the anterior areas, none are available for the posterior temporal area. Such larger temporal implants have to be custom made and are of typical widths of 5 to 7mms at their most central areas. They can be placed either in the subfascial or submuscular pockets. The submuscular position eliminates any risk of edge visibility in the anterior temporal area. More remarkably such large implants can be placed through a small postauricuar inciseon for a non-visible scar.

Case Highlights:

1) Augmentation of the width of the upper third of the face/head may be desired when the lower two-thirds have been previously augmented for facia balance.

2) Total head width augmentation requires a custom temporal implant approach.

3) Custom temporal implants that cover the entire side of the head can be placed through a postauricular incision for ‘scarless’ surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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