Narrowing of the wide or overly convex side of the head is done by a soft tissue reduction of the temporal muscle. While many think it requires a bone reduction technique the reality is that muscle removal is far more effective and can be done by a hidden incision behind the ear. The temporal muscle is thicker than many think even the posterior portion over the convex part of the temporal bone.
Temporal muscle removal is a hard technical concept to understand as how it is performed aesthetically is completely hidden from view. But like all aesthetic procedures it is one learned from its use in more reconstructive craniofacial surgery which is performed openly through a bicoronal incision. Int rare instances I still perform an open coronal scalp incision for various aesthetic skull and forehead reshaping procedures where the temporal muscles are largely exposed. In a recent case skull bone reduction was requested along with head narrowing as well. This provide the opportunity to see openly how a temporal muscle reduction is performed.
After the forehead and skull bones were reduced attention was turned to the side of the head where the temporal muscle covered by the deep fascia could be seen. In a line from the upper forehead obliquely down to the ear the fascia is opened vertically exposed the muscle.
Using electrocautery a full thickness muscle cut is made down to the bone from the bony temporal line superiorly down through the thickest part of the muscle by the ear. Then the posterior temporal muscle is removed in its entirety.
The discrepancy between the removed posterior muscle and the remaining anterior muscle could be appreciated, a difference of 7 to 9mms by the top of the ear. The posterior edge of the exposed anterior temporal muscle is then pulled out and removed, leading most of the anterior muscle mass.
The temporal fascia is closed back together, having a dampening effect of the posterior part of the anterior muscle for a smooth transition across the fascial closure like. When the scalp is closed over the muscle removal area it appears both reduced and smooth
Dr. Barry Eppley
World-Renowned Plastic Surgeon