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Temporal implants can be placed as part of a facial rejuvenative procedure and one way to place them is through the brow lift procedure. This is a superior vertical approach coming from above to open the deep temporal fascia just below the bony temporal line. Once opened a subfascial pocket is developed which should be similar to that of the implant…long and narrow.

But despite the favorable circumstances for temporal implant placement malposition is always possible in a procedure that is partially blind. Ideally it is helpful to have a 3D CT scan when performing temporal implant repositioning so a full understanding of where the implant actually is can be known. In this example it can be seen that the right temporal implant is in perfect position while the left one is positioned more back and up.

 Once the implant positions are established then how the pocket must be expanded AND how part of the pocket that is going to no longer used can be closed to prevent relapse back from whence it came. That latter is equally important as the former as temporal implants are composed of ultrasoft silicone to which the capsule does not adhere. The pocket must be changed by a combination of expansion and contraction.

The best place to put the incision for temporal implant repositioning is direct if possible. Direct means as close to the implant as possible either at its edge or directly over it. This gives one the best control both expanding the pocket and closing down part of the pocket that will no longer be used.One such location is right at or just behind the frontal hairline. Exposure of the implant is easily done and from this location both maneuvers can be successfully completed. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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