Temporal implants offer an assured volume increase in correction of aesthetic temporal hollowing. They are available in two styles, standard and extended. The extended temporal implant style was developed to offer a more complete temporal augmentation effect from the zygomatic arch up to the bony temporal line. Two thickness are available from thin (3mm) to fuller. (6mm)
Since the majority of temporal implants are done in females, more times than not they are best treated by the extended temporal implant style. Also since many females that have temporal hollowing are thinner (not always but frequently) it is important to not overdo the amount of augmentation and go with the thinner size so the temples do not become disproportionately full.
In placing any temporal implant, and the extended style in particular, it is important to minimize the incision as much as possible. It is important to remember that placing silicone implants in particular is not like ‘putting a pizza in the oven’. If it were the incision would be as large as the implant is long or is wide. But because they are flexible (can bend) the size of the incision can be quite small. It only needs to be big enough to allow an elevator to be placed through it to develop the subfascial pocket on top of the muscle.
Because the extended temporal is much longer than it is wide, a useful technique is to make the incision high up in the anterior temporal hair bearing region. This allows the implant to be placed parallel to its length aids not only its introduction through the incision but also allows it to be more easily unfold and positioned in the subfascial pocket. In addition this incisional placement is above the anterior superficial temporal artery branch so the incision down to the deep fascia can be done without running into it. It is usually best to make the incision a small zig zag, carefully placing it between the hair shafts. The incision make look small compared to the implant but it will be able to pass through it.
Once the implant is passed through the incision and into the implant pocket it is extremely important to ensure that it is completely laid out flat. This is done by placing an elevator under the implant and making sure all edges are laying flat. The very top of the implant can be seen through the incision, which is the thinnest part of the implant and it should be laying passively flat. The fascia can then be closed over it prior to the skin sutures.
The effects of temporal augmentation are immediate and the key to sizing and placement is that it looks smooth and not too full after they are placed during surgery. The high small incision helps ensure that their placement is laid out flat and that its inferior end is positioned as close to the zygomatic arch as possible.
Dr. Barry Eppley