Will A Custom Temporal Implant Provide A Better Long Term Solution Than Hydroxyapatite Cement?

Q: Dr. Eppley, I am a 29 year old female and have had temple augmentation with bone cement (hydroxyapatite) around 8 years ago. At the same time, I also had some of my brow bone burred down through a coronal incision (to get rid of that neanderthal look) and a brow lift to reattach the muscles and skin in a natural position.

I was initially very happy with the results, but over time the hydroxyapatite has somehow disintegrated and I am now back to having hollow temples (and a narrow head shape in general).

I am now looking for a more temporary solution and am thinking of temporal implants. Specifically, I am looking into custom-made temple implants starting at my temples and extending to the side of my head (I attach pictures of similar augmentations I found on your website).

Further, I am thinking about further burring down my brow bone bossing and – while the coronary incision is already open – potentially also reducing the radix of my nose (not sure if this is possible through a coronary incision though, but I thought this may be possible and would be really interesting to know). More precisely, I asked the surgeon back then to undercorrect the bossing and not lift my brows more than necessary as I wanted the most subtle of results. After eight years during which my brows have had time to drop again, I am now looking to redo this (but this time properly without undercorrection).

Before scheduling a consultation with you, I wanted to reach out and make a quick inquiry about feasibility and cost (I understand that this is very individual but a ballpark price would be really helpful to know whether I can afford surgery with you) to make sure that I don’t waste your time with an unnecessary consult. If possible, I would be really grateful if you could give me some initial answers on following questions:

!) Can the radix of the nose be shortened through a coronary incision?

A:Thank you for your inquiry in detailing your prior surgical history and present concerns. In answer to your specific questions:

1) You are referring to custom temporal implants that provide augmentation to the anterior and posterior temporal areas. Well such an implant would normally be placed doing an incision in the crease of the back of the ears of your existing coronal scalp incision provides unparalleled access for their placement.

2) since your first brow bone reduction procedure was done by burring the critical question is whether are the anterior table of the frontal sinus Will now permit more bone burning reduction or whether it is now so send that any further reduction requires a bone flap technique. Only a 3D CT scan, which would be needed to design custom temporal implants anyway, couldn’t make that accurate assessment.

3) Significant reduction of the high radix typically requires a bidirectional osteotome technique. One cut needs to be made from the internasal approach along the dorsal line and then a 90° superior cut either needs to be made in a percutaneous fashion or, as you have mentioned, from an existing coronal scalp incision. The coronal approach of course would never be used for a high radix reduction but in your case if brow bone reduction is going to be done this would be a convenient way to do the superior bone cut.

4) while a coronal incision does provide the opportunity for a brow lift I would be cautious about the mechanism by which that occurs. Hey Coronel brow lifts by removing a strip of scalp at the incision location. In other words one is going to sacrifice some hair to do it. It is hard for me to be enthusiastic about that concept. I would rely more on the effects of the implant augmentation and some internal suture plication to the bone rather than to sacrifice any hair for a modest brow lift.

Dr. Barry Eppley

World-Renowned Plastic Surgeon