The anatomy of temporal hollowing: the superficial temporal fat pad

A coronal incision provides exposure to the lateral craniofacial skeleton for plastic surgeons, oral-maxillofacial surgeons, head and neck surgeons, neurosurgeons, and cosmetic surgeons. A common complication of this approach is hollowing of the temporal fossa. This hollowing results in a significant cosmetic deformity that affects the patient physically and psychologically. Current theories suggest that hollowing may result from atrophy of the superficial temporal fat pad resulting from ischemia, displacement, or denervation of the fat pad. The purpose of this study is to identify the neurovascular supply and the supporting structures of the superficial temporal fat pad. Eight fresh-frozen cadaver heads were injected with latex to facilitate identification of vessels. Through coronal incisions, the anatomy of the vessels, nerves, and fascial network within the superficial temporal fat pads were recorded. The vascular supply of the superficial temporal fat pad includes branching perforators from the deep and middle temporal arteries that traverse through the substance of the fat pad. The branches of the zygomaticotemporal nerve travel through the superficial temporal fat pad. There is a network of septations that suspends the superficial temporal fat pad to the anterior fascia. This is the first step to understanding the etiology of postoperative temporal hollowing. This study provides the basis for a prospective, randomized clinical trial investigating temporal hollowing after different surgical exposures of the area.