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Ligation is an effective procedure in reducing and/or eliminating the prominence of temporal arteries that appear on the side of the head and run into the forehead. Shutting off the flow through the artery reduces its size and as a result its appearance. While this concept is obvious and seemingly simple it is harder to execute than one would think. Arterial flow into the scalp is anastomotic from one side of the scalp to the other with numerous interconnections. As a result shutting off one point of flow is not a guarantee that pulsatile flow through the artery will be reduced.

This anatomic understanding has led to the technique of multi-level ligations along the course of the superficial temporal artery. This addresses both forward (anterograde) and backward (retrograde) flow which allows the artery without pulsatile flow to collapse. Such ligations are done through small incisions at select points along its course into the forehead…which is determined by a visual assessment of the artery’s pathway.

But in doing the ligations a visual or palpation check is not a reliable indicator of when the blood flow has ceased. Arteries are prone to spasm due to their muscular walls and once manipulated at one location can cause a constriction at some or all of its length. Such constriction can make it seem that the arterial flow has been eliminated if only looking at or feeling it. The definitive test is with the use of a doppler. This device detects blood flow, particularly that of pulsatile arterial blood flow. 

It is used to check for flow in the artery after all the marked ligation sites are completed. If no signal is detected then no more ligation sites are needed. If a signal is detected then at least one and maybe more locations sites may be needed. The doppler will help pinpoint where those ligations sites need to be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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