The sometimes aesthetically prominent and often pulsatile artery that crosses from the temporal hairline into the forehead is the anterior branch of the superficial temporal artery. This can be very effectively treated by a multilevel ligation technique through very small incisions. Typically three microincisions are used located at the temporal hairline, lateral forehead and right upper forehead. These are placed along the visible path of the artery with the goal of cutting off forward and backward flow through the artery as well as cutting of feeder flow from the supraorbital artery.
During surgery all three ligations are done and then the flow through the vessel is checked with a doppler. This is a more sensitive test than just looking and feeling for flow through the vessel. The procedure is not considered complete until a doppler signal through the vessel is eliminated.
In some patients the three ligation points do not completely eliminate detectable flow through the artery. This can occur from inflow from unseen sources, the most common is an arterial branch off of the main temporal artery that occurs way before it turns into its more superior Y split. This is sometimes shown in anatomic depictions. This inflow will be missed by the traditional three ligation points.
In these cases a fourth ligation point is needed lower on the arterial tree. Using a small incision at the back end of the sideburn hair the main superficial temporal artery can be ligated. This ligation is lower than the takeoff of the unseen feeder vessel. To date it has successfully resulted in elimination of the residual doppler signal that can persist after the the anterior branch of the superficial temporal artery ligation has had the three traditional ligations done.
The preauricular sideburn hair incision for temporal artery ligation cuts off the anterograde flow from the larger main trunk below all of its branches. It heals with an imperceptible scar. It is also the same incision that is used for cheekbone reduction surgery to perform the posterior zygomatic arch osteotomy.
Dr. Barry Eppley