The desire for reduction of the width or convexity of the side of the head is mainly seen in men with short hair or a shaved head. While it is commonly perceived that this is a bone problem and only correctable through its reduction, this is anatomically erroneous. The more definitive and scar free method to do so is through muscle removal, specifically the posterior temporal portion. This is the portion of the muscle that covers the convex shaped temporal and parietal skull bones above the ear. When the muscle over this area is removed, an immediate and very visually apparent narrowing of the side of the head.
This muscle is removed from an inferior direction from an incision behind the ear. While there is no true anatomic distinction between the anterior and posterior temporal muscles, one has to be made in performing this procedure. An obliquely oriented full thickness cut is made through the muscle from the superior helical root of the ear up to the bony temporal line. This allows what lies behind it to be completely removed but stops short of where the muscle dives down into the deepest portion of the temporal fossa.
The temporal muscle is removed but its overlying fascial lining (deep temporal fascia) is preserved. This is an extremely important part of the procedure by the way the muscle is cut. With a thick cut edge of the anterior muscle left behind this poses the risk of creating a visible edge as the scalp behind it shrinks inward. While the muscle edge will eventually undergo atrophy and pose less of a visibility risk, having a tight and intact overlying fascia helps dampen this transition area in the short term.
As the fascia needs to be incised to expose the muscle at the incision behind the ear, it is important to close it as best as possible after the muscle is removed. This re-establishes fascial tension over the muscle edge for less visibility. It may not always be possible to get the fascial edges completely together but as close as possible achieves maximal tension across the muscle edge.
Temporal reduction by muscle removal is a remarkably effective procedure for head widening. Since there is no way to partially remove or thin the muscle from a hidden postauricular incision it is necessary to remove the entire thickness of the muscle. A tight fascial closure over the entrance at the top of the ear helps decrease the risks of visible muscle edge visibility.
Dr. Barry Eppley