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Prominent temporal vessels, often commonly called ‘worms’, are overly dilated branches of the superficial temporal artery that appear on the side of the forehead. Why they appear in some people and not others is not known. Certain characteristics are associated with the prominent temporal arteries such as a male patient who often has a thinner/leaner face. It may be men have thicker arterial walls with more musculature in them as well as less fat in the temporal region which makes them more visible. But these are not absolutes as I have seen them in women as well.

While the reason prominent temporal arteries occur may not be known, how to treat them is known. Ligating the artery at various locations along its visible course has a high rate of making them less visible and even invisible with a sustained lack of visibility long-term. At least three ligation point are done along the course of the visible artery in which two are often beyond the temporal hairline and out onto the exposed forehead. The technique is to extract the exposed arterial loop and place one or two sutures around both sides of the loop. The artery is severed or cutting half after the ligations to lower the risk of potential bleeding if a ligature should come close later. What matters is that the flow is stopped.

The incisions for the placement of the suture ligations is done through small skin incisions of 5 to 6mms in length. The most exposed incisions on the forehead are placed in static wrinkle lines or wrinkles one that appear when raising the eyebrows. The scars from these small incisions do very well and are difficult if not impossible to locate when they are well healed. To date, no patient has requested any scar revision surgery for them.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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