Q: Dr. Eppley, I feel my cheeks are a bit large so want to reduce their appearance as well as my upper outer brow bone. From the side my eyes look sunken, not for the front though. I feel that maybe reducing the brow and cheek bone would make eyes stand out and not seem so deep set from side view. However, I also have hollowness on direct sides of nose by nostril and have tried filler but it didn’t help. I also like my nose profile but from front, it looks wide around the tip so also looking into narrowing it from front view. Thank you for your help!
A: In looking at your pictures. I would not disagree with your contention about altering the bone to try and open up the eye area. There are two fundamental approaches to doing it. One option is a tail of the brow reduction through an upper eyelid incision combined with intraoral cheek reduction either done by burring or an anterior body zygomatic osteotomy. The second approach is a coronal incisional approach for lateral brow, lateral orbital and zygomatic reduction. (I think this approach is more than you need) From a nose standpoint you are describing two nasal issue, a paranasal deficiency and a broad nasal tip. Your nose concerns could be addressed by paranasal implants (placed through the same incision as for the cheek reduction) and a closed rhinoplasty for tip (dome) narrowing.
Dr. Barry Eppley
Q: Hello, I just have a few questions about a cosmetic issue that I have been dealing with for really all of my life, but just became totally aware of within the last few years. I have a condition called Plagiocephaly. I’m sure you know what that is, so I won’t go into that. I will say, however, that I have a flat spot on the left side of my head. It has caused my left ear to protrude, and my left brow ridge(the part that the eye brow covers), also protrudes. It is very noticeable, especially to me, but others do notice it too. My question is whether or not I can have a procedure done to either A.) Reconstruct the left side of my head and brow ridge so it looks more symmetrical with the other side of my head, or B.) Just correct one of the two areas. I really would like both done and I would like to know about scarring and what would they look like, and whether they would be covered by my hair or not.
A: The physical changes that you have described are classic for occipital plagiocephaly in children and adults in which the condition was not treated early or was felt not to be severe enough for traditional skull molding therapy. On the same side, one can have a flat spot on the back of the head, a brow protrusion and an ear that sticks out more than the other side.
All three cosmetic problems can be effectively treated through known plastic surgery procedures. These include an injectable occipital cranioplasty using Kryptonite material (limited scar technique), a simple ear setback (otoplasty) , and a burring down of the tail of the eyebrow (brow bone reduction) using an endoscopic technique. All three can be treated during a single operation or only the most bothersome can be treated alone.