Decreasing the width or excessive convexity of the side of the head is performed by a procedure known as temporal reduction. This is an operation in which the full thickness of the posterior temporal muscle belly is removed. This is done through an incision placed in the crease of the back of the ear (postauricular sulcus) so it is a surgery that has an invisible scar.
This is a tremendously effective procedure for reducing the wider head. But it has several common misconceptions about it which can be resolved through an understanding of the temporal anatomy. The side of the head is composed of a combination of soft tissue and bone. It is often perceived that the side of the head is largely composed of bone but that is not true. Axial slices of 2D CT head scans will show that the thickness of the temporal bone makes up only about 1/3 of the side of the width. This varies based on where is at along the temporal region. In the anterior part by the side of the eye the soft tissue composition is the greatest. This soft tissue thickness becomes less the more posterior you go. But at the mid-temporal region, which is generally above the ears, the muscle is equally as thick as the bone.
Most patients tell me they know the thickness at the side of their head is bone because it feels hard. This is understandable as that is the way the side of the head feels. Even when clenching one’s teeth and the muscle bulges it still feels hard. But like wallpaper on a wall, the soft muscle will feel firm like the underlying bone even though it is just as thick if not thicker than it is.
At the very end of the posterior temporal muscle right before it transitions to the back of the head, the ratio changes and the muscle becomes thinner. This is why to reduce parietal eminence’s to necessary to reduce bone as the muscle has a minimal effect on it.
Dr. Barry Eppley