The temporal region of the head is an historically overlooked and under appreciated area of aesthetic augmentation. Standard temporal implants have become available in the past ten years for the permanent treatment of temporal hollowing. But this area of the temples is limited to the anterior or non-hair bearing region by the sides of the eye. Behind it lies the much larger and longer posterior temporal region which extends from the anterior hairline the whole way to the back of the head. While not often thought of as being to being capable of being aesthetically enlarged, it can.
The anterior and posterior temporal regions can both be enlarged by the placement of subfascial implants.Placing an implant on top of the temporal muscle but under its fascial covering provides an effective augmentation without any implant visibility. Bur when the entire side of the head needs to be enlarged (both anterior and posterior temporal regions) the implant placement usually needs to be on top of the deep temporal fascia. This is because the implant usually needs to cross the anterior and posterior bony temporal lines for a smooth contour to end up on the bony forehead and occipital bone.
In total temporal (combined anterior and posterior) implant augmentation, also known as head widening implants, they are usually placed through a postauricular (behind the ear) incision. Small scalp incisions may also be used as a triangular positioning and fixation method but the postauricular incision is primary. This makes the implant placement virtually scarless which seems incredulous given its size.
I recently performed a custom head widening implant on a female patient who has pre-existing scalp and preauricalar/temporal scars from prior facial rejuvenation procedures. This certainly simplifies its placement coming from above as opposed to traditionally coming from below. Part of the scalp incision is used to dissect down from the bone onto the deep temporal fascia. To ensure that the inferior edge of the implant sits low enough a small segment of the facelift scar is used.
The head widening implant offers a unique and powerful effect and its size would m make one think that large incisions to place it would be needed. But to the contrary it is actually placed through a small hidden incision. But in this case there was no reason to not use the generous scars that already existed from prior surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon