Reduction in the width of the side of the head (head narrowing) is most commonly done by removal of the posterior belly of the temporalis muscle. Many people understandably think that the width of the head above the ears is mainly due to bone but that assumption is usually incorrect. While the bone makes some contribution the more significant tissue adding to the protrusion is the thickness of the muscle. At thicknesses of 7 to 9mms in many patients, reduction of the muscle can make a dramatic change in the bitemporal distance of up to 1.0 to 1.5 cms.
My typical approach to temporal reduction has been through a vertical incision above the ear. The incision is about 4 to 4.5 cms long and runs about halfway towards the superior temporal line. While this temporal scalp incision usually heals very well and often in an indiscriminate manner, there is always risk of some visibility of the scar particularly in those men that shave their heads or have very closely cropped hairstyles.
A completely hidden scar approach to temporal reduction is to place it behind the ear in the postauricular skin crease. This incision allows direct access to the thickest part of the posterior temporal muscle above the ear and permits additional muscle removal above and behind it. Whatever muscle it can not reach from the incision will atrophy and shrink down later as the muscle in front of it has been removed. Some temporal bone reduction can also he done within a range of 3 to 5 cms from the superior end of the incision.
Closure of the postauricular incision with resorbable sutures results in a very fine line scar in an undetectable location. This temporal reduction approach takes no more time to complete and makes it a more palatable option for many male patients.
Dr. Barry Eppley
Indianapolis, Indiana