Q: Dr. Eppley, I am a young man with symptoms of moderate plagiocephaly. The left-back side of my head is flat, the left eye and cheekbone is slightly higher and more prominent, my right eyebrow is lower and the eyelid sags heavily compared to the left, my right ear is pushed outwards and pulled back compared to my left one, and my jaw is wider on my right side. I noticed this completely about a year ago but most of my life I have felt like there was something off about my face. I’ve never been “bullied” by my appearance but I’ve been told from friends that I have a weird head or crooked eyes. Most people probably don’t notice right away but I feel like it is holding me back from completely enjoying my life and being content with my appearance. For example I cannot wear glasses because they look crooked when I put them on and I’m afraid to get a haircut because it is very noticeable how much larger the right side of my head is than the other.
A few potential surgeries in helping my appearance maybe be augmenting the left back side of my head, reducing some of the thickness on the right side by burring the bone and removing some temporalis muscle, adding prominence to my right cheekbone and filling out my left jaw. I’m not looking for perfection, but I feel that adding and taking away from the right spots and micro-adjusting my features would help me look a lot better.
I’ve done quite a bit of research on my condition but I cannot find any clear answers on what would help me. I would greatly appreciate any input you have on how I could improve my facial balance and asymmetry and bring out the natural good looks I believe I deserve to have.
A: Without seeing pictures of you I could not make any specific recommendations, but all the face and skull procedures you have mentioned are classic ones for correcting craniofacial plagiocephaly issues. (crooked face and skull) Occipital augmentation of the flat side of the back of the head and burring reduction of the contralateral protruding side of the back of the head are good skull reshaping options. Unilateral cheek augmentation and unilateral jaw angle augmentation are good facial ershaping options. Since you have identified those areas they would undoubtably all be collectively beneficial for improved craniofacial symmetry.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some form of skull or face reshaping. I would like to know based on the photos/info provided what would you assume is the cause of my skull/face defects? So basically I have a protrusion of my right forehead area as well as on the scalp area (right side mainly)and extends but decreases to the left side of my top head area giving a “Gumby” appearance, slanted, lopsided wichever one. I also have a cone looking shape on the back top of my head, as well as my right jaw is sunken in slightly, my right ear is further back than the left, and my right eye slightly bulges. Hopefully this info gives you some clues to let me know what I may have. I would also like to know the best approach to fix the issue and if possible see what it could look like if corrected. Thanks a lot.
A: Everything that you are describing and demonstrating in your pictures is most likely the result of a congenital skull plagiocephaly anomaly. This is fundamentally a developmental problem with the skull base from which the skull and face shape becomes slightly twisted and asymmetric. The key question now is what can and should be done with the constellation of skull and face asymmetries that exist. While there are numerous surgical procedures for all of these issues, they are aesthetic trade-offs (scars) for doing so and these must be considered very carefully. The question that I would ask you is which one or two of these issues bothers you the most and would like to see improved/corrected?
Dr. Barry Eppley