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Background: While temporal augmentation can be done by injection techniques, implants provide a permanent effect. There are different styles and thicknesses of these implants so most patients can use them off-the-shelf for their temporal augmentation needs. They are also very modifiable in surgery so the implant length can readily be adapted to the patient’s distance between the superior bony temporal line and the inferior zygomatic arch.

Temporal implants can be placed through different incisional approaches. As temporal implants are very soft, as they are designed to feel like muscle and they are usually not very thick (4mms), the location of the incision for their placement can have a significant effect on how their aesthetic effect as well as the risk of complications (implant folding/bending) 

In the style 2 temporal implant which is vertically longer than it is wide a superior incision location is preferred. This allows the implant to be introduced along the axis of which it is designed. This is usually done through a superolaterallyt located incision in the temporal hairline above the anterior branch of the superficial temporal artery. But any scar that exists in the neighborhood can be used. (e.g., frontal hairline advancement)    

Case Study: This female had lost weight and developed temporal hollowing and now desired temporal augmentation. Extended style 2 standard temporal implants of 4mm thickness was chosen for her augmentation. She had a prior frontal hairline advancement.

Under general anesthesia and using the very tail end of the frontal hairline advancement, direct access to the deep temporal fossa at the bony temporal line was made.

The fascia was opened and a subfascial pocket developed down to the zygomatic arch.The implants were slide into the pockets and the fascia closed over them. The skin incision was closed with a few dissolvable sutures.

The improvement in the temporal fullness was visibly apparent once the implants were placed.

Key Points:

1) Subfascial temporal implants are the permanent method for correction of temporal hollowing.

2) In the style 2 extended temporal implant its long vertical length requires its placement through a superior incisional approach.

3) The tail end of a frontal hairline advancement can serve as the entry point for temporal implant placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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