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The development of visible temporal arteries in the forehead is not rare. Occurring almost exclusively in men, the frontal or anterior branch of the superficial temporal artery becomes dilated and its course up into the forehead becomes prominent. Often occurring after exercise, heat exposure or alcohol intake, the muscular walls if the artery dilate makes its course very visible. In some patients the size of the artery may decrease but in other patients it may persist for days. While this is largely as aesthetic issue, some patients complain of associated headaches and even visual blurring.

Temporal artery ligation is the surgical treatment for such aesthetic forehead vessel dilatations. It should be not confused, however, with the ligation technique done for temporal arteritis or temporal artery biopsy. While that procedure does ligate (and remove a section) of the vessel, its intent is not to stop the flow through the artery. It is to remove a section of the vessel for pathologic analysis. Any blood flow reduction is an inadvertent side effect.

But aesthetic temporal artery ligation is done with the intent of ceasing flow through the prominent section of the artery. If flood is diminished or eliminated it will no longer be visible. While it may seem like ligating the vessel before it ever enters the non-hair bearing temporal and forehead areas should work, it often by itself does not. This only treats one part of the problem, inflow or anterograde flow. It does not account for back flow or retrograde flow which comes from the cross-connections across the scalp.

The real key to the procedure is to carefully trace the pattern of the vessel forward and look for branching points. At these identified branching points ligations must be done to cut off back flow once forward flow is eliminated. This can be difficult to always completely identify as the artery has a very tortuous pattern in the forehead. Sometimes they are visible but many times it requires careful palpation to find them.

The number of temporal artery ligations points will vary for each patient but can range from two to seven. The average number is three per side. Men who shave the head or have closely cropped hair often undergo more ligation points due to greater vessel exposure along its length. In the forehead area it is also important to place the small incisions in natural skin wrinkle lines which can be found by having the patient raise their eyebrows.

Dr. Barry Eppley

Indianapolis, Indiana

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