Can Head Width Reduction, Cheek Bone Reduction and A Custom Occipital Implant Be Done During The Same Surgery?

Q: Dr. Eppley, I am interested in getting head width reduction surgery, cheekbone reduction surgery as well as surgery to augment the back of my head. The first photo I attached is in regard to head width reduction and cheekbone reduction surgery. From the info on your website, I see you do removal of the muscle after the yellow line in my photo.  I am curious to know if you can do removal of muscle after the red line in my photo. Also, I will always have very short hair on the side, since it make my head looks smaller. How visible will the scar be after the width reduction with my short hair? 

I had a cheekbone reduction before but my surgeon didn’t reduce any more cheekbone after the first blue line in my photo due to concern of nerve damage. Since most of the width of my face is in between the two blue lines. The cheekbone reduction i had is largely ineffective in making my face more symmetrical and narrower. I was wondering if you are able to reduce the cheekbone between the two blue lines where my previous surgeon was concerned with nerve damage 

Lastly is in regard to the augmentation of back of my head, my current head shape is similar to the baby in the second pictures. I am curious in getting a custom implant to make my head look more normal.I consulted with a craniofacial he advised me against a custom implant because of high risk of infection. How high is the infection rate of these implants, and How much will total cost of this specific surgery be including getting a 3d CT scan, a custom implant made, and all the other fees including surgeon fee? 

A: When it comes to temporal muscle reduction, the actual line of reduction is from the top of the ear angling upwards to just behind the temporal hairline along the forehead, so it is in front of the red line that you have drawn. Most of the incision is behind the ear and it is done largely endoscopically above it.

The cheek bone a you are illustrating is the tail end of the zygomatic arch where it attaches to the temporal bone. If this part of the cheek bone is not fractured inward with the front part, little change in cheek bone width will result. An osteotomy is done in that area through a small incision at the junction of the beard skin and non-hairing skin. The temporal branch of the facial nerve runs in front of this incision so there is no risk of nerve injury. This is actually a standard approach to cheek bone reduction osteotomies as both the front and back ends needs to be cut and moved inward.

I have done many custom occipital skull implants as well as many other implants for other skull augmentation areas. I have yet to see an infection so the claim that they are prone to a high rate of infection has not been my experience.

Dr. Barry Eppley

Indianapolis, Indiana