Aesthetic Correction of Temporal Hollowing: A Review of the Literature and a Novel Algorithm for Management

Introduction: The temporal hollowing deformity is characterized by a notable concavity of the temporal fossa normally defined by the underlying bony structures including the temporal, sphenoid, frontal, and parietal complex with overlying temporalis muscle and the temporal fat pat. The etiology for the defect has been attributed to several factors including vascular compromise of the temporal fat pad, the temporalis muscle and/or denervation of the latter. Defects or deficiencies in the underlying bony architecture can also be a contributing factor. Although the defect is common in both the adult and pediatric population secondary to surgical procedures and in some soft tissue wasting entities, prior to this study, a logical algorithm to guide the treating physician in analysis and treatment of a patient has heretofore not been formally presented.

Methods: A retrospective chart review was performed of all patients treated for temporal hollowing over the past ten years. Data on aesthetic outcomes and complications was collected. A directed treatment algorithm replacing the affected structures using fillers, fat grafts, bone, soft tissue and alloplastic grafting was created.

Results: Based on our analogous and personal experience in treating over 150 surgical patients with temporal hollowing over the ten year period, we have designed a paradigm based on the underlying etiology of the presentation. In our large and comprehensive series there were no major complications, and we have had good to excellent correction of the deformity based on independent review of the results as well as formal objective MRI studies.

Conclusion: Based on our extensive clinical expertise in combination with data gleaned from previously published studies our innovative algorithm predictably corrects the temporal hollowing defect effectively and reproducibly without major complications, confirmed by the ten year time span of this study. The analysis and corrective methodology is easily learned and can be effectively applied by the average surgeon. Furthermore, our experience has enabled us to predict the temporal deformity at primary craniofacial and skull base cases enabling the treatment plan delineated in our algorithm to be applied to a primary procedure thereby obviating the late treatment of the temporal hollowing deformity previously described with our algorithm. Analysis and treatment of the temporal hollowing deformity using our paradigm belongs in the armamentarium of all plastic surgeons.

Fig. 1

Figs. 1 and 2 Pre-Op and Post-Op Clinical Photographs of Alloplastic Skull Reconstruction followed by Second Stage Dermis Fat Fascia Graft.