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Temporal artery ligation is the only method to treat prominent arteries in the temporal and forehead area. An aesthetic condition that occurs almost exclusively in men, enlarged branches of the anterior superficial temporal artery develop as the arterial branches spread out after exiting the temporal hairline. In men who shave their head the arteries become apparent back in the temporal hairline. Unlike veins which may be treatable by laser or sclerotherapy, such is the not the case with the much higher flow artery.

Temporal artery ligation involves two basic steps, arterial pattern recognition and the actual ligation method. Vessel pattern recognition is extremely important and can be the more difficult of the two. Defining the ligation points to shut off both anterograde and retrograde flow is to ensure that the vessel is no longer seen and its flow and enlargement does not return later These ligation points have to be carefully evaluated and selected as the entire length of the vessels are not always seen. Palpation is often necessary to search for arterial pulsations.

The vessel ligation involves three considerations; 1) in situ or extracted ligation, 2) single or double ligation and 3) dissolvable/permanent sutures or vessel clips. The artery must be approached from very small incisions (5 to 7mms in length at most) as this is still an aesthetic procedure. It may be easier sometimes to pull the artery out of the incision for ligation rather than working inside a small ‘hole’. The strong muscular walls and vessel stretchability allow this to be done.

The exposed temporal artery can be singlely or doubly ligated. When in doubt it is always better to tie it off twice for ligation security. Whether this is done with resorbable or permanent sutures can be debated. But if one is doing a single ligation then a permanent suture can be used. If it is a double ligation then resorbable sutures can be used. If small vessel clips are used a double application is just as easy as placing a single clip.

Dr. Barry Eppley

Indianapolis, Indiana

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