Your Questions

Q: Dr. Eppley, I have prominent bulging temporal arteries bilaterally. My regular plastic surgeon is against arterial ligation in the area of my temples, out of fear that once one artery is ligated, another will pop up in its place, and thus conveyed to me that there is no surgical solution to bulging temporal arteries (the squiggly pulsing arteries on either temple, they have been confirmed to be arterial.) id love to schedule a consult with one of you surgeons. I am in California so I would need to meet virtually or over the telephone, but I would gladly make the trip to your facility if it is determined that there is a probability of success in treating this issue. It is very difficult to find a surgeon to perform surgery on this area. Thank you!

A:In my extensive experience with temporal artery ligation surgery I have never seen other new vessels appear after such ligation surgery. So your plastic surgeon’s theory (and that is what it is when the surgeon has never actually performed the procedure) is unfounded. This is undoubtably because the ligations are done at multiple levels along the course of the artery. The actual risk of the surgery is recurrence along the existing arterial pathway, not the appearance of new vessels. But even recurrence of any portion of the artery is very uncommon, again due to the multi-level ligation approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, About temporal reduction surgery. I checked some images on your website about the temporal reduction and saw that the ears get extremely bent for 180 degrees during the surgery. This could be a big problem because I had both ears set back a couple of times and especially the left ear took 6 surgeries until it was more or less OK and closer to the head. I’m afraid that this method could tear something in the ear apart so that they protrude again. Could you give me some more information about this please.

A: That is an understandable concern but not on in which has occurred even in patients with prior otoplasties. That being said one way to limit that concern is to move the incision a bit away from the depth of the postauricular sulcus out more behind the shadow of the helical rim.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been interested in rib/waist size reduction for most of my life. From the moment I was born, I had large ribs. 

That being said, the concept of rib removal has always felt terrifying and littered with too many negative side effects. I’ve known some people that have had it and they have mentioned that they have lost the ability to do some of their basic lifestyle activities. Cycling, weightlifting, etc. Bending in specific ways. 

It has always boggled my mind that someone has never thought of a way to do this by reshaping the ribcage. I always thought dentists and orthodontists do incredible things with teeth. Increasing jaw widths, moving teeth, etc. 

After continually searching, I finally found a procedure pioneered by a process of Waist Narrowing without Removal of Ribs. I was curious if you were familiar at all with this procedure and/or if you or anyone else in the United States had began its implementation?

A: Thank you for your inquiry. I have done hundreds of rib removals and have never see the complications/lifestyle limitations you have described.

But that issue aside I am very familiar with the rib fracture technique which is simply a scaled down version of the rib removal procedure, limited to ribs 11 ands 12 and relies heavily on postoperative corseting. Whether it is as effective as the more complete approach to rib removal surgery I can not say but my feeling is that it is for the patient who is more comfortable with a less invasive procedure and is willing to commit to 2 to 3 months of corset use.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am German Male and 2 years ago I underwent a chin wing surgery for 5mm forward movement. I am now looking to reset/reverse this procedure. I am aware that a full reversal chin wing, brings various risks with it. Particularly, the resuspension of the mentalis muscle seems to be a challenge often articulated, when conducting research on the internet. 

1. Judging by your cases and personal experience, how likely is it that a patient will need additional surgery for a mentalis resuspension after a full reversal of a chin procedure (genio/cw). 

2. As I live in Germany, I am looking for a qualified surgeon in Germany. Do you have any personal recommendations?

A: In answer to your chin wing reversal questions:

1) Mentalis muscle resuspension would be done as part of the chin wing reversal as prevention is better than finding out later it is needed.

2) and 3) I do not have any familiarity with German surgeons so I can not be helpful in that regard. Although it would seem most logical to have the surgeon who performed the procedure undergo the reversal??

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have just discovered your clinic, I am delighted because I have long wondered if it is possible to have implants on the forehead as well as the skull, in order to have the upper face wider and rounder, as women with a big forehead  often say are more attractive! That’s why I come to you because I’m interested in this intervention. I would like to have the same surgery that you posted on your Instagram page on January 26, 2022.

A: Custom forehead implants is a procedure that I commonly do. All. forehead implants have to have some amount of extension that extends onto the top of the skull to blend into bone in as smooth fashion. If you send some pictures of your forehead I can so some predictive imaging on potential forehead augmentation changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had buccal fat reduction about a year ago and am less than happy with the results, I am wondering if there’s a permanent procedure you can do to restore some of the fat that was taken out. Please let me know, thank you!

A: Reversal of buccal lipectomies can be done two permanent methods, buccal space fat injections done externally or the direct intraoral placement of a dermal-fat graft back into the buccal space. Each approach has is advantages and disadvantages. Fat injections are less invasive, acquire the injectate by liposuction harvest but like all fat injections their volume retention is unpredictable. A dermal fat graft is the true buccal lipectomy reversal is that a piece of fat is put back directly by which it was removed with a high volume retention rate but it does require an excisional harvest from somewhere on the body. 

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, Hello! 6 months ago i have a kick direct in to my forehead glabellar bone, and even now i have some times pain in the hole inward in my forehead. Please, I need help with that, i am from Romania and here the doctors recommend me lifting mods for be cheapest. But the pain, and even blocked sinuses some times, are knockin me down most when i try to sleep, or do sport, or i go outside when are much than 77 degrees Fahrenheit. More than that the hole also make me feel uncomfortable sometimes about esthetically. I write this message with the hope can you help me, after i see all the results of you work on this website page. Thanks for the time accorded to read. 

A:If I understand your situation correctly you probably have an inwardly displaced fracture of your frontal sinuses (brow bones) creating a depressed dent in the glabellar region as well as a sinus blockage. I would need to see some pictures of your forehead to confirm. But the treatment would be frontal sinus fracture repair, most likely using a cranial bone graft.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello. I’m 28 years old. I already got testicular implant surgery 1 year ago, and planning to replace it with bigger implants. But there were no existing implants bigger than 40cc. Do you make those custom implants with 3D implants? Or do you carve it? 

A: All testicle implants over 5cms are custom made by a 3D design process. I have made and placed testicle implants up to 7.5cm with 110cc volume.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, s it possible to change the cheekbone’s shape/cheek hollowing (to a straighter, higher set one)? I‘ve been reading a lot about “the high cheekbone” look, custom infraorbital malar implants and zygoma reduction osteotomies, and there’s something I haven’t seen mentioned. 

Most people getting zygoma reduction are Asians (and don’t have the high cheekbone look in mind) and most people getting custom infraorbital-malar implants have very flat cheekbones to begin with. 

My question is: 

Can someone that already has hollow cheeks change their shape? Let’s say, someone with cheekbones like Jon Kortajarena or this morphed face (prominent, with a curved inwards shape) wants to obtain more straight, vertical cheekbones, like Henry Cavill or this other morphed face. Is that possible to achieve? What procedures would be necessary to do so if possible? 

I’ve attached you photos of people with the lower set, curved cheekbones (Kortajarena, Morphed face 1) and the higher set, more vertical ones (Henry Cavill, Morphed face 2). 

Would love to hear your thoughts about this.

A :As long as the need is augmentation to achieve the more ideal cheekbone shape then anything is possible with 3D designed implants. If a bony reductive change is required to achieve that shape then the type of change achievable is more limited.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My eyes are so asymmetrical they stick out like a sour thumb in every picture and in certain lighting. I really need to do something about this but I don’t even know where to begin because every doctor says something different. It’s definitely orbital asymmetry. What can be done about this?

A:Thank you for your inquiry and sending all of your pictures. What you have is a classic vertical orbital dysfopia (VOD) probably in the 3mm range. In VOD the eyeball and all structures around it are positioned lower than the other side. While the eyeball can be raised up the correction is not quite that aesthetically simple as all the surrounding structures (eyebrow, eyelids and cheek) are made for where the eye is now. So just moving the eyeball alone will actually make the asymmetries worse.

There are two fundamental approaches to VOD…complete correction or camouflage. Each approach has its advantages and disadvantages. In complete correction all the structures are treated. (raised)  In camouflage the eyeball is left alone and the most obvious causes of the surrounding asymmetry are treated. (e.g., eyebrow and eye corner lifts) See attached imaging to show the differences.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been reading about hip augmentations specifically iliac crest implants, and the silicones ones you’ve been offering. My question is, do you think the South Korean version (the titanium implant) is even safe the way you would have to put the screws in incase of removal? Also, I was wondering if you’ve yet had any patients with your silicone version, as I am highly interested and how safe those are for removal, as well as price ranges. I check for updates almost every day. Thank you!!

A: Thank you for your inquiry and sending your pictures of which I can appreciate your interest in iliac crest implants. In answer to your iliac crest implant questions:

1) Titanium iliac crest implants are safe but you are referring to how easy they would be to remove if necessary. (reversibility) They can still be removed as the screws merely need to be backed out to do so. There is not that much tissue adhesion to metal other than any perforations in the implant’s surface.

2) Silicone iliac crest implants, which have their own appeal and still require screw fixation, awaits the first patient for implantation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a genioplasty two weeks ago and I hate the results. I’m a 23yo female and my chin now looks square and strong. I wanted to know how long I should wait to get it reversed since I don’t want my soft tissues to sag if I wait too long. I would like to schedule a virtual appointment with you to talk about it. The after pictures are the ones with the white shirt and the rest are the before. Thank you

A: I am sorry to hear of your initial dissatisfaction with the early results of your sliding genioplasty procedure. While it is true that early swelling can make one think their result is excessive when I get contacted by a patient who hates their early result they do not change their minds later about it when the swelling subsides. The two questions that matter then is 1) when should the revisional surgery be done and 2) it is total or subtotal genioplasty reversal. I did not see any before pictures in your inquiry and I do not know if you had preoperative computer imaging so you could look at various options of chin augmentation change but there was a reason you had the initial surgery so usually it a subtotal as opposed to a total reversal in most cases. I would need to see the preop pictures and do imaging to help you make that decision. In regards to timing, if you are absolutely sure this is not the result you were seeking then sooner is better than later.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I am interested in looking into the buccal fat removal procedure. I am looking for a way to make my face less ‘puffy’ and round especially when smiling. I was interested in finding out if this could be an option for what I’m looking to achieve. Thank you!

A: Thank you for your inquiry and sending your pictures. The cheek fullness to which you refer is anterior to the buccal fat pad and thus this procedure would not be effective for you. In addition any form of surgery is geared toward static problems while your primary cheek concerns are dynamic in nature. I(smiling) In other words there is no effective surgery for cheek fullness that primarily appears when one is smiling. Your facial concerns are extremely common but I know of no procedure that I can confidently say will solve it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently had a lip lift which has turned out extremely unflattering, I would like a second opinion, to see what if any procedure can fix it, as I am avoiding being seen and dreading returning to work, I have chosen to not pursue a revision with my surgeon because I believe I may need a corner lift now and I do not believe he does them anyway and I don’t want to risk a second surgery not knowing what to expect and prefer a more experienced surgeon in this field. I know I probably cant have surgery for 6 months but I cant just wait around not knowing when, where, or how I am goin to fix this, and if I have a consult now we can plan a surgery and I can get filler or something in the mean time and then dissolve it before surgery hopefully. My mouth now appears to be very downturned at rest as apposed to horizontal like before my surgery, and my lift seems a lot in the middle and ends before the end of my lip especially on the left side. I look forward to hopefully hearing from you soon thank you for your time.

A: Thank you for your inquiry and sending your pictures. What you have is a classic A frame upper lip deformity from a subnasal lip lift. Such a lip lifting procedure mainly affects the central or cupid’s bow region of the upper lip. Its effects do not extend as far out as the outer lip or mouth corners. This occurs when the absence of significant lateral upper lip vermiliion show is not recognized beforehand. This is where the value of the Q tip lifting test before surgery can be helpful.

That being said you can never reverse a subnasal lip lift as the skin removal is permanent. It is true that there will be some relapse of the lift (up to 20%) within the first six months after the procedure but that never really changes the upper lip vermilion disproportion that is now present. That is treated by lateral vermilion advancements for the outer aspects of the upper lip to create a more harmonious vermilion fullness from one mouth corner to the other. (see attached imaging)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How much height can be achieved with skull implants? I’m a model and additional height is never a bad thing. What is the average thickness of a “flat head” implant? What was the largest you’ve done?

A: In answer to your top of the skull augmentation questions:

1) The amount of skull height obtained in the immediate placement of  skull implant can be up to 1cm,,,which is how much the scalp can stretch to accommodate it.

2) Larger amounts of skull augmentation can be obtained with a first stage scalp expansion procedure in which I have done as much as 3.5cms of added height.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I want the custom anterior temporal implant design for a head widening effect. My questions are: 

1. what are side effects. 

2. In case after surgery it is too pain, is it possible to get the injected filler out and back to normal.

A:  In answer to your custom temporal implant questions:

1) Such facial implants are not associated with any significant pain so this is not a concern.

2) Any type of facial implant can be removed if so desired although removal due to excessive pain is not a patient problem I have yet encountered.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested to know if you do 11th and12th rib resection for medical problems as those 2 ribs are pushed inward and up causing pain.I have a case of my left 12th rib syndrome .My 12th rib is not touching my pelvis, its angulated up and inward,being to close to my 11th rib and 11th and 12 crossed toward ends of the ribs.12th rib kind of under 11th, and 11th to curvy and gets stuck under 10th I want to discuss with you rib resection.

A:The typical reason for the medical treatment of ribs #11 and #12 is for ilio-costal syndrome caused by the excessive length of those ribs…which I have done numerous times. Whether that would be effective for those two ribs because they push inward and up I can not say for sure but presumably it would and it requires their length reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Are there skull implants for the side of the skull that could give me a square head shape? 

A: You have correctly surmised that to get a more square head shape you do have to build up the sides along the bony temporal lines. Whether that is done with two separate implants or one implant that thinly crosses the middle can be debated. (see attached) But most likely in your case it would be the former.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question about jaw implant revision surgery 3 years ago when I put two silicone jaw angle  implants. While one stayed in the correct position and I’m very happy with it, the other one moved a bit or was misplaced causing a bit of an asymmetry which I solved these past years with filler on that side. As I’m looking for a more permanent solution I was considering a revision surgery and was wondering if it would be possible to use the implant I already have and maybe fix it with a a screw so it doesn’t move and if there are many risks compared to the first surgery. 

Many thanks for all the help,

A: In theory if the one jaw implant side is satisfactory and the other one isn’t then it is an implant positioning problem not an implant style or size problem. Therefore one should be able to reposition the unsatisfactory side with screw fixation and achieve a satisfactory outcome. BUT don’t ever try to reposition an implant unless you know precisely the position of both implants with a preoperative 3D CT scan.

The risks of jaw implant revisional surgery as the same as the original surgery albeit half since it is only one side.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to improve my side profile of my mouth area and would love to consult with you virtually if possible. 

I am considering a Lip Lift. As well as a Bottom Lip reduction + Chin Implant to address droopy, hanging lip that exposes the bottom gum when mouth is at rest. I also am aiming to address the pronounced outward appearance of the upper mouth. 

Am I a candidate for these procedures ? I have visited 3 orthodontists in the past who have said that I do not have dental issues.

A: Thank you for your inquiry and sending your pictures. What you have is a smaller recessed chin, a large by sagging lower lip and a general bimaxillary dentoalveolar protrusion. (but with a good bite. While your general concepts about treating these are are correct there are some changes to them that would be better:

1) A sliding genioplasty would be far better than an implant when you have a short chin with lower lip incompetence. (sag) A lower lip reduction can be done at the same time. (see attached imaging)

2) I would be very cautions about a traditional upper lip lift when you have lip incompetence (lower lip sag) as that works against improving that issue.

3) You can not improve your bimaxillary dentoalveolar protrusion (pronounced mouth protrusion) with extensive presurgical orthodontics and major double jaw surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in getting chin and jaw implants. I was wondering how long the waitlist is for that. I’m getting married mid November so was hoping he would have an open slot sometime in August.

A: Thank you for your inquiry. I would be very cautious about doing facial implant surgery close to a very important social and life event. By doing so you are banking on that no complications will occur and you will look and feel perfectly normal. Three months will be the minimum time I would do that before someone’s wedding which will be fine…provided no medical (infection) or aesthetic issues occur. (asymmetry, too big etc)

That being said the next question is whether standard chin and jaw angle or a custom jawline implant is needed. I would need some pictures to do imaging to determine what type of aesthetic jaw augmentation change you are seeking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a cyst removed from my left cheek. It left a very noticeable dent on that side of my face. I’ve been searching for a plastic surgeon to fix this issue for a long time. I’ve been getting filler injected into that area, but it dissolves (or moves) from that spot really quickly (about 2 months). I also still have the unfortunate problem of having an active cyst right next to the scar. I don’t want to remove it anymore since it has pretty much destroyed my cheek area. I’m writing to you because one surgeon who I had a consultation with talked about doing a cheek implant which sounds like a better idea than maybe getting a fat graft or more filler. I’d just like your perspective to my problem (and you would definitely be my pick for doing an implant). 

A: I would question the logic of putting a cheek implant deep on the bone with the hope of its push from ‘far away’ would reduce a contour depression closer to the skin area. I would doubt that would work thew way you want. It would also make the right cheek now bigger than the left, creating its own aesthetic issue.

However to make a more informed assessment I would need more than this one picture from an oblique view. I would five pictures. (straight on, sides, both obliques and a view with your head tilted back to show both cheeks from below.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How many weeks after buttock implant surgery will I need to wait to go back to work? iu will need to be able to sit in meetings for up to 3-4 hours comfortably.

How much swelling would I have?

Will I have any restrictions? Driving or Exercising?  

Do I need a special pillow for my bottom?

A: In answer to your buttock implant recovery questions:

1) I think it will be in the 4 week range before she can sit comfortably for extended periods of time.

2) While all implanted tissue swelling after surgery, the amount of swelling in the buttocks has never been a stated concern by patients as I suspect whatever swelling occurs is viewed favorably. Actually you are the first person who has ever asked me about swelling after buttock implant surgery.

3) I would refer back to #1 as it relates to driving. Exercising is closer to 6 weeks.

4) I have never used any special pillows for buttock implant surgery.

The key to the entire recovery process is protection of the intergluteal incision from excessive stress or shearing forces. The rest of the recovery issues relate to patient comfort.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What are your complication and revision rates for infraorbital rim-malar implants? In particular, I am concerned about asymmetry and eyelid retraction. Fyi, I plan to get lateral canthoplasty too. I had emailed you pictures previously, but am not asking for any evaluation with this particular question, just wondering about complications. Thanks.

A:In my extensive experience with custom IOM (infraorbital-Malar) implants, while potential issues of postoperative implant asymmetry and lower eyelid retraction are possible, they are very uncommon and not what constitutes the main reason for revisional surgery with these implants. The by far most common reason for IOm implant revisions are patients whio make their implants too big initially or are too conservative initially and and bigger later. This size issues is what constitutes 90% of all custom IOM implant ‘complications’.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I really admire your work. I am considering a brow bone implant as well as a custom wrap around jaw implant  with you a few years down the road. I just have a few concerns that I was hoping you could address. 

1. If I have a recessed mandible (my bite is normal) and my chin isn’t recessed, could I still achieve a strong side profile with a chin implant instead of orthognathic surgery? Or would it just look out of place by having a big chin with a small jaw? I love the way my side profile looks when I slide my jaw forward, but my bottom lip moves with my chin, which obviously wouldn’t happen with a chin implant. I’m going to attach some pictures of a celebrity that has basically the same recessed look that I have

2. Would you be able to make the brow bone implant angle downwards instead of a straight?  

3. Is it possible for me to get a vertical chin implant (apart of the wrap around implant) that also has a a custom square shape? 

4. Is the black and white pictures face shape (his face is wide, long, and angular) possible for me to achieve with a wrap around implant that adds both height and width to the mandible, and height, width, and square shape to the chin? 

5. Do you plan on retiring within the next few years? 

Thank you!

A:In answer to your questions:

1) How any facial change looks on a face requires computer imaging to be done to answer the question in any meaningful way. Someone else’s face doesn’t count, only your face does.

2) Custom implant designs are done in any shape to try and achieve the desired effect.

3) But definition a wrap around jawline implant includes the chin which can have a square shape.

4) Refer back to answer #1.

5) No

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have severe plagiocephaly and It is difficult for me to live with it, so I would be very interested in your services. 

But I have a few questions, because this is not a operation that has to be taken lightly. 

So if I understood correctly, to correct the plagiocephaly, you use an implant that you put over the skull. Meaning that you don’t cut, move the bones of the skull, right ? 

So does that mean the technique of the implant over the skull has less risks to fail than the operation where they move the bones of the skull to position them in a bettter way ? 

If it fails what are the consequences? (Brain problems?) 

Other questions, what is the durability of the implant ? Does it last forever ? 

Is it solid ? Will it not move ? 

And how is the implant fixed to the skull ?

A:In response to your adult plagiocephaly surgery questions:

1) You have correctly surmised that in adult plagiocephaly it is treated by an extracranial implant augmentation.

2) Extracranial operations have none of the risks associated with intracranial procedures. They are typical implant-associated risks like any other aesthetic solid face or body implant.

3) Skull implants are solid, do not undergo material degradation, will not move and will last the patient’s entire lifespan without needing adjustments for any of these issues.

4) Skull implants are permanently secured into position by small screws, perfusion holes and an encapsulation process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in having my Perioral Mounds removed. Am I a candidate for that procedure?

A:Thank you for your inquiry and sending your pictures. While your ‘perioral mounds’ can be treated by liposuction that is not the best treatment for them. They are actually tissue that has drifted forward as part of the aging process, creating mounds of skin in the perioral area. Thus they do not represent isolated fat collections with good quality overlying skin which is the requirement for a good liposuction reduction result. Rather the far superior procedure is a lower facial tuckup procedure (lower facelift) which moves these sagging tissues back along the jawline/lower face for a smoother and rejuvenated appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to please ask if you could assist me with forehead reshaping surgery. I find the profile of my forehead very straight, and I’m looking for it to be more convex and backward sloping. Is this an achievable goal?

A: Thank you for your inquiry and sending your pictures. Your forehead profile is very straight for two reasons, 1) the upper forehead is very developed and 2) the brow bones are not. Thus in changing your forehead slope to a more retroclined angle the options include upper forehead reduction and brow bone augmentation. Upper forehead reduction alone is helpful in that regard but because of the limitation of the thickness of the frontal bone it will only change the slope so much. (see attached imaging) Adding projection at the lower end of the forehead (brow bone augmentation) helps tilt the angle back more. (see attached imaging) In the examples you have provided both of those men have more pronounced brow bones.

Dr. Barry Eppley

Indianapolis, Indiana