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Augmentation of temporal hollowing can be done by a variety of materials from injectable fillers and fat to implants. Each has their advantages and the best quality of an implant is its assured volume permanence. Temporal implants are made of a solid ultrasoft silicone material which is designed to feel like soft tissue…which is exactly what it is replacing. (fat atrophy) While it sits on top of the temporal muscle it is placed under the dense deep fascia above the muscle so any risk of edging or implant show is eliminated.

One of the common indications for temporal implants is in the older female. Females as they age, particularly if they are thinner, tend to lose facial fat which often is most manifest in the temporal areas. The sunken temporal regions contribute to the aged appearance and is a good area for volume rejuvenation. They often undergo facial rejuvenation procedures (e.g., blepharoplasty, facelift) which is an opportune time for temporal implant placement.

In placing temporal implants the placement of the incision can be done at several different locations . Most commonly these are done back in the temporal hairline where the incision is more hidden and access to the subfascial place is uncomplicated. The style (shape) of the temporal implant will influence where the incision is placed. Most female temporal hollowing patients need to augmented the full temporal area for which the extended temporal implant is used. Because this is an implant that is taller than it is wide and being soft and very flexible it is best to use a high incision location. This not only avoids the transverse pathway of the anterior branch of the superficial temporal artery but it allows the implant to be introduced along its vertical axis…which decreases the risk of unrecognized implant folding.

The extended temporal implant is vertically long and is designed to lie between the temporal line of the forehead and the zygomatic arch of the cheek. It is longer than almost any female patient would need. As a result is often needs to be shortened and this is what the lines in the implant are made to do. The implant should always be shortened from the bottom, preserving the fine tapered edge at the top of the implant. Once placed the temples should look smooth with no visible implant show. Only the skin needs to be closed as there is no benefit to close the fascia.

Like all implants creating an adequate pocket and getting the implant into the desired position in that pocket is critical in allowing the implant to have its desired effect. Temporal implants are no different with the exception that their placement is completely blind. Once the implant is in the pocket it can not be seen. Because the extended temporal implant is long and fairly thin (usually 4mms) it can easily fold on itself and have a slightly different orientation than desired. Placing it superiorly along its vertical axis helps lessen that potential intraoperative implant placement risk.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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