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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Case Study – Forehead Asymmetry Surgery


Background: The forehead occupies a full third of the human face and sometimes than that based on the location of the frontal hairline. While the forehead does not draw one’s attention, like the lower two-thirds of the face due to the sphincteric motion of the eyes and mouth, its broad surface can not be overlooked.

Forehead asymmetries are not that uncommon and can result from a variety of causes. One of the most common is that from plagiocephaly where the twisting of the entire skull creates well known front and back of the head asymmetries.  It is also seen in varying degrees of isolated frontal facial asymmetries with the smaller facial side having less forehead projection and a lower brow bone position.

Another less common cause of forehead asymmetry is iatrogenic from prior surgery. In performing brow bone reduction or more superior frontal bone reshaping, slight bony shaoe differences may exist or be created between the two sides. While not apparent during the actual operation, these slight differences may become revealed after surgery as the tissues contract down around the expanse of the broad forehead.

Forehead AsymmetryCase Study: This young middle-aged male had a prior history of brow bone and forehead reduction surgery. While it took months after surgery to see the final shape of his forehead, it eventually showed a forehead/brow bone asymmetry that was confirmed by a 3D CT scan. The left brow bone, in particular, and the upper forehead were flatter than that of the right side.

Intraoperative Custom Forehead Implant 2 Dr Barry Eppley IndianapolisIntraoperative Custom Forehead Implant for Asymmetry Dr Barry Eppley IndianapolisBecause he already had a full coronal scalp incision, a full open approach was done for wide open access to the forehead. Using PMMA bone cement a thinly design implant was fashioned to visually match that of the right side. The edges were burred down to be very thin at their perimeters. It was secured into place with two small microscrews.

Left Foreheasd Augmentation Dr Barry Eppley IndianapolisHis after surgery results show improvement in his forehead shape between the two sides. Careful inspection shows just a hint of the outline of the bone cement application which is surprising given its paper thin edges and the thickness of his scalp tissues. Whether he may eventually undergo a revision for this aesthetic tradeoff remains to be determined.


  1. Forehead asymmetry can be created by brow bone and forehead reduction surgery.
  2. One method of bone augmentation for forehead asymmetry surgery is that of the use of bone cements which requires a wide surgical access for application.
  3. Any method of forehead augmentation requires the smoothest transition between the material and the natural tissues to avoid any visible lines of transition.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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