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Biomaterials for Correction of Temporal Hollowing: A Systematic Review
Nusaiba F. Baker PhD1, Omotayo A. Arowojolu MD, PhD2, Raj M. Vyas, MD, FACS2 1 Emory University School of Medicine, Emory University, Atlanta, GA, 30307, USA 2 Department of Plastic Surgery, University of California, Irvine, Orange, CA 92868

Background: Temporal hollowing can be a consequence of craniofacial and neurological surgeries and is the most common complication reported in neurosurgical literature. Etiologies include disruption of the superficial temporal fat pad during surgical dissection, displacement of the temporalis muscle, or aging. The objective of this review is to systematically review the literature identifying biomaterials for correction of temporal hollowing defects for both aesthetic and reconstructive indications and to compare the techniques, outcomes, and cost.

Methods: A systematic review was performed using PubMed, Web of Science, Scopus, and Cochrane searching terms related to temporal hollowing and biomaterials. Data were collected on type of biomaterial, indication, application technique, patient satisfaction, and complications. A case series on the senior author's experience using titanium and hydroxyapatite for post-craniotomy temporal hollowing correction was included. A cost comparison was performed collecting data from PubMed and hospital administration.

Results: Two thousand and sixty-six studies were identified and 34 met inclusion criteria. There were 11 aesthetic, 22 reconstructive, and 1 combined study. Biomaterials were classified into 3 modalities: 8 studies investigated autologous fat (24%), 6 investigated fillers (18%), or 20 discussed solid implants (59%). Autologous fat, hyaluronic acid filler, or calcium hydroxyapatite filler were the most common biomaterials reported for aesthetic indications. For reconstructive indications, fat and solid implants (including titanium, polymethylmethacrylate, and high-density polyethylene) were the predominant biomaterials investigated. All biomaterials had greater than 80% patient satisfaction reported. Overall complications reported included postoperative infection (7% in titanium studies, contour irregularity (8.6% in polymethylmethacrylate), and pain on mastication (6% in fillers cohort) and swelling (70% in fillers). Moreover, a combination of titanium and hydroxyapatite cement is a technique used by the senior author with positive outcomes. Cost comparison demonstrated PEEK ($7,000) and customized titanium implants (up to $20,000) were the most expensive biomaterials.

Conclusion: Filler and autologous fat are cost effective options for aesthetic correction of temporal hollowing. For larger temporal defects requiring complex reconstruction, solid implants including customized patient-specific implants or combined titanium/hydroxyapatite implants are effective for achieving superior contour, durability, and integration.

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