I know this is an old thread, but I faced the same issue: surface mounted medicine cabinet 4 7/8" deep. I found a Kohler Tone 3-light vanity fixture Model #31770-SCO3- BNL (brushed nickel one) that was perfect. It extends 10 3/4 inch out, but it's only 6 inches high. It was beautiful, but after ordering from Lowe's, it went from delivery 6/12 to delayed to out of stock. Damnitall. Whoever reads this...it will be available in October, 2023. I talked to a Lamps Plus clerk who said the entire bulb must fully extend out past the medicine cabinet to avoid all shadow. This Kohler model does that. I had to totally switch gears to a fixture that pointed up. I hope it will work to provide enough light. I'm not as thrilled about it, but you have to be practical to get the bathroom remodeled in time. I hope this is helpful. Good luck to all who face this issue!

Canofworms - I have to run & will reply this aft or tomorrow, but for now will post something I copied... in case it helps another newbie like me: http://www.thisoldhouse.com/toh/article/0,,403815,00.html (A Lesson in Bathroom Lighting); excerpts: "Task Lighting Vanity lighting gets top consideration because these fixtures work the hardest to illuminate the head and face for grooming. The most common mistake people make is putting recessed ceiling fixtures directly over the mirror. These cast shadows on the face, making daily grooming rituals more difficult. Vertical fixtures or sconces mounted on either side of the mirror are best for casting an even light across the face. But given the size and positioning of some vanity mirrors, sidelights can be impractical (mounting them directly to the mirror is always an option, but at greater planning and cost). Only then do I suggest a fixture for over the mirror. It should be placed 75 to 80 inches above the floor and, like all vanity lighting, contain at least 150 watts ÂEideally spread over a fixture that's at least 24 inches long so that the light will wash evenly over the hair and face. The shower is a secondary area of task lighting. In smaller bathrooms, if the stall has a clear glass door, a dedicated fixture may not be necessary. Otherwise, I recommend a recessed light with a glass lens (plastic will yellow). Similar recessed fixtures work well over a freestanding tub or the toilet. " "Lighting the Vanity Right To eliminate shadows under the chin, eyes, and cheeks, fixtures should be mounted on either side of the vanity mirror (or on the mirror's surface, if it's large), 36 to 40 inches apart. The center of each fixture should be roughly at eye level, or about 66 inches above the floor. This will guarantee even illumination across the face for grooming...." "Choosing Bulbs A crisp white light tends to render skin tones most accurately. Halogen bulbs set the gold standard...." "Think Dimmers These are a lighting designer's best friend because they grant absolute control over the lighting, and thus the mood, of the room. In a very small space like a powder room, dimming the vanity fixtures might even provide all-in-one task, ambient, and accent lighting. Plus, dimmers conserve energy...." Here is a link that might be useful: A Lesson in Lighting - This Old House

There are a variety of reasons why one would go with either a surface mount vs recessed cans such as Pro 1. Cheaper installation costs than recessed cans. 2. Easier installation. 3. Small kitchen. Cons 1. Recessed cans can be placed near or directly over work areas while the surface mount will invariably be located in the center of the room. 2. Some people find the styling of a T-8 fixture unappealing. 3. Most T-8 fixtures cannot be dimmed. Dimming Fluorescent fixtures are more expensive. Alternatives - panel lights or the Cree CR24/CR14 troffers.

In my opinion, I would use the recessed lighting and other layered lighting that is in your plan. I would not add a centered light. I think you will have a cleaner, more contemporary look without the additional light. I put recessed lighting in two kitchens and was extremely happy with the result. If you feel more light is needed, you could always add additional recessed lighting in center of the wider room.