Skull Reshaping

Q: Dr. Eppley, I been looking Into skull reshaping procedure for years now, and your website has been very helpful. But I need the back of my skull shaved down but I can’t find no information on numbness? So do this area come with numbness and if so long long can it last?

A: Every time a scalp flap is raised to perform any skull reshaping procedure, whether it be augmentation or reduction, there will be some numbness that will occur over the raised scalp flap areas. Most of this numbness is temporary and is self-resolving over time. I have yet to have a patient tell me that they have any bothersome numbness on the back of their head after any occipital skull reshaping or reduction procedure.

On the back of the head coming up from the sides at the base of the skull are the greater occipital nerves. They supply a lot of the feeling across the back of the head as well as coming further forward along the scalp. These nerves run above the bone in the soft tissues of the scalp. Any type of skull reshaping procedures raises the entire scalp off of the bone, thus the nerves are protected from being injured or cut which would be a cause of permanent numbness.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reshaping

Q: Dr. Eppley, On your website you seem to do plastic surgery related to skull reshaping. Has there ever been a case where someone had macrocephaly or a head circumference of 24.5 inches where you reduced this to 22 inches? I don’t think burring would accomplish that much. Would a craniectomy (or removing part of the skull) accomplish this or is that too dangerous. I have been able to reduce the size some myself by constricting and applying pressure to the scalp from different angles in a similar way a baby is fitted with a cranial mold. 

A: The simple answer to your skull reshaping question is that burring is all you can do. You are not going to a craniectomy for an aesthetic skull size concern for a number of reasons including surgical risks, bony irregulatiies and, if nothing more, sheer cost. That is an operation that will cost $50,000+ to do with a neurosurgeon.

No one is able to have their skull reduced by 2 inches or more in circumference even with a craniectomy. (you have forgotten to take into account the space the brain needs which will tolerate no inward push)

Whatever reduction you have obtained by ‘compressive wrapping’ of the scalp, burring reduction will at least do that if not more. But burring reduction is the only aesthetic skull reshaping option you have.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reduction

Q: Dr. Eppley, I am trying to figure out if there is a cosmetic surgery that exist for skull reduction. I am a female with a 25.25 inch head circumference and it has been the joke of my life since birth. I already have to have jaw surgery because of my underbite, but I am praying that maybe there is some way to make my bobble head less noticeable. I tried gaining weight so that the weight could bring proportion, but unsuccessful. I know that this may sound silly to some, but this is my life and if I could change this, I will. I don’t expect to ever wear a hat, but I would at least like to face the public without having to cover my head with long hair or look down while walking.

A: There are a variety of skull reduction procedures that can done for just about anywhere on the skull. What is important to understand about them is that they treat selective areas which can be used to change some of the contours of the skull. In rare cases, there is even overall skull reduction by burring. These procedures can not, for example, take a 25 inch circumference of the skull and make it 21 inchs around. But in many cases they can make a visible difference which could provide a psychologically substantial improvement in how the patient sees the size of their head.

Whether these type of skull reduction procedures may be of benefit for you would require that you send me some pictures of your head for my assessment.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reduction Scars

Q: Dr. Eppley, I am contemplating seeing you for sagittal ridge reduction surgery.  My understanding is that the resultant scar will be 5 to 7cm in length, from left to right, at the crown of my skull. I am Caucasian with “medium” toned skin.  While the prominence of the sagittal ridge bothers me tremendously, I’d like to get an idea of how well the scar will heal in order to determine whether surgery will be worth it.  I’ve done an Internet image search for “scalp scars” and the search returns pictures from hair transplantation surgeries, brain surgeries, etc…  A lot of these scars are quite prominent, and it’s difficult for me to figure out what a “fine line” scar actually means in my case. So my questions for you are:

1) How well do sagittal ridge surgical scars heal compared to other cosmetic surgical scalp scars?  Since the surrounding skin is tight at the crown region of the skull, I’d expect there to be tension on the scar, which would make it wider.  Is that true?

2) What can be done, if anything, to improve the scar once healing has occurred.  Is Fraxel effective?  What about other dermatological techniques?  Are there concealer creams that can be used on a daily basis to hide the scar?

3) Do you have more before/after pictures of scars that you can post?

Skull Reduction scalp scar result Dr Barry Eppley IndianapolisA: Your questions and concerns about the scalp scar from skull reshaping surgery is understandable and appropriate given the elective aesthetic nature of the surgery. Searching the internet will not be helpful since just about every surgical scalp scar you see is not what scars from this type of surgery will turn out. There is no comparable other skull/scalp surgery to which this applies. In answer to your questions:

These type of scalp incision usually heal remarkably well and ion many patients can be very hard to detect. These are not scars in which there is any tension since this is a reductive operation not an augmentative one.
There will be no scar treatments that are needed. I have yet to do a scalp scar revision from one of these surgeries as they heal so well. I do many skull recalling surgeries on bald/shaved men and the scar is usually very slight at worst.
Attached see an example of a scalp scar in a shaved head male who had sagittal ridge skull reduction.

Dr. Barry Eppley
Indianapolis, Indiana

How Effective Is Skull Reduction?

Q: Dr. Eppley,  I am struggling with my confidence as a result of having a big head. I have read lots of articles on your webpage, and I would really like to do have something done with my head size. It is basically just big in every dimension. So I would like to do these surgeries: 

1. Narrowing of head. (Partly removal of the temporal muscle and burring of bone) 

2. Shorten the length of my head from my forehead to the back of my head. 

3. I would like to reduce the height of my head. (For instance by burring down the sagittal ridge)

I have always had a quite big head, but I was involved in an accident recently, which provoked a bump on the back of my head. So my questions are, how much would it be possible to reduce the skull in the questioned areas?

A: You have highlighted the five site specific skull reduction locations (front, top, back and sides) where reduction procedures are possible that can have an effect on overall head size. It is hard to put an exact number or percent as to how much head size reduction would result from these collective efforts Since every patient is different with varying amounts of head size protrusions and bone thicknesses, each case has to be evaluated on an individual basis. The question is not whether one can perform all these skull procedures but whether the end result justifies the effort. I would need to see pictures of your head from different angles to provide an answer in your case. Ultimately a CT scan is needed to assess the thicknesses of the bone and muscle which also helps in making that determination.

Dr. Barry Eppley

Indianapolis, Indiana

Is Skull Reduction Surgery Safe?

 Q: Dr. Eppley, I am curious about my options regarding skull reduction surgery. I believe I have a pretty normal skull shape but I’d like to smooth down the bump on the lower back of my head, I believe it to be the occipital although I’m not certain. From where the top of the back of my neck transitions to the skull it seams like a bit more exaggerated of a curve than normal. I was curious if it would be an option to smooth it down, if allowably possible. Let me know if you have any questions or what you would initially require in order to assess. I would be willing to take an X-ray or CT scan if necessary. Thanks.

A: The prominence of the occipital bone can be burred down, usually about 7mms across its entirety based on its inherent thickness. The question is not whether it can be done but whether enough can be safely removed to make a difference. That can be simply answered by a plain lateral skull x-ray which will show how much skull reduction can be obtained by the removal of most of the outer cortex. It is not advised to go past the outer cortex of the trilaminar skull layers.

Dr. Barry Eppley

Indianapolis, Indiana

How Much Skull Reduction Can Be Safely Done?

Q: Dr. Eppley, I asked you about my skull shape problem before but I don’t think I’ve describe it accurately.The problem with my “big head” has been troubling for years and I hope to resolve it once and for all.

Here is my problem:

My head looks normal when viewed from the front or back. But when viewed sideways, it looks big. Specifically, the distance between the forehead to the back (the occipital region) is too large.

If one would to look at the top of my head from a bird’s eye view, the back region is sort of a “trapezoidal” shape, in that the middle portion protrudes too much out. I wonder if it’s possible to “push back” on the middle portion and fill up the side, so that the head will be a more flat or rounded shape rather than trapezoidal.

I think the only way this can be done is via a partial removel of the skull, and putting it back like a jigsaw, or maybe even replacing that portion with an artificial skull. I wonder if this is within your specialty. I heard the risk of death or disablement from this might be as high as 50% so I might not do it if that’s the case.

My goal is to reduce the said distance between the forehead to the back by 20mm. On your website, most of the skull reduction procedure I’ve read about deals with mechanically removing a portion of the skull and making it thinner. I’m not sure if that would be enough in my case. I’ve read that the human skull thicknes is only about 10cm thick at most.

A: Realistically what you are asking can not be done. The outer portion of the skull can be shaved down by removing the outer cortex. When done in the forehead and occiput, the anteroposterior (front to back) distance can be reduced probably 10 to 12mms at best. You can not remove skull pieces and put them back together any way you want because of the space occupied by the brain. This space can not be reduced or intruded upon, only the outer portions of the skull can be reduced which protects and maintains the intracranial space for the brain.

Dr. Barry Eppley

Indianapolis, Indiana

How Successful Is Skull Reduction Surgery?

Q: Dr. Eppley, How successful are skull reduction procedures? How many have you done and what have you learned by doing them?

sagittal ridge skull reductiion result side view Dr Barry Eppley IndianapolisA: Skull reduction refers to different reductive procedures of the cranium. These can be smaller isolated problems like lumps, bumps and the occipital knob, which are usually like osteoma growths. It can also included reduction of prominent sagittal ridges and other high spots due to mild disturbances in sutural and fontanelle closure.Occasionally overall skull reduction can be done but there are limits based on bone thickness as to how substantative that type of skull changye can be. Having performed over fifty specific skull reductions of various types, I would say that they have all been successful. This is not to say that there have not been some revisions of these skull reductions to make further improvements such as smoothness and more aggressive reduction effort. But the key in skull reduction surgery is patient selection and knowing what the limits of the procedures are. You can not just reduce any portion of the skull any amount one wants. Reductions can usually only be done as far down as through the outer cortical layer just into the diploic space.

Dr. Barry Eppley

Indianapolis, Indiana

 

Can Skull Reduction Surgery Be Done To Reduce One’s Head Size?

Q: Dr. Eppley, I am inquiring about skull reduction surgery. I have read online said that you can reduce the head. I have always been very conscious about how wide my head Is. It’s wide and big. What can you do exactly? May I send you some pics so you see what I am talking about? I also am losing hair and I read on your website that you don’t recommend the procedure for hair loss. But I am not entirely sure how you narrow the head, mine is very broad. I often wear hats because I am self conscious about my wide head and hair loss.

A: Thank you for sending your pictures and expressing your concerns. There are procedures that can very effectively reduce the size of your head including temporal muscle reduction and bone burring. (skull reduction) There is no doubt in my experience that they could change the way you see your head. However, to do these procedures one needs a scalp incision to do it and with your hair loss I would have grave concerns about the remaining fine line scar from the surgery. Thus in your case I would seriously question that aesthetic trade-off. You don’t want to trade one problem for another. While there are trade-offs in every aesthetic procedure, what one trades into should be perceived as being better than what they currently have.

Dr. Barry Eppley

Indianapolis, Indiana

Can Skull Reshaping Be Done To Reduce My Head Size?

Q: Dr. Eppley, I am interested in skull reshaping surgery. I am a 35 year old female who is concerned about head size and shape. My head is wide and big overall. Especially, the top and the sides of parietal bone are bulged so that it is really difficult to find hats to wear. I hope to reduce the top and side portions of my skull as much as possible. Having the surgery done is only way to get to rid of my life long distress. Is it possible for a patient who lives outside of the US to get this surgery done? The hardest part for me is to take a long absent from work so the time is my big concern. How many visits are required before and after the surgery? If I am sure to have the surgery, is it possible for me to visit you first time and get the surgery done in a week or so? I could possible use the weekend for before and after consultations. Another concern is that I need to visit and get through it by myself. Would that be okay? 

I am sending you some pictures. Because of my thick hair, it might be hard to understand my head shape. But my hair is wet and pushed to my skull. I would not say my head is deformed. The head shape is like an apple. Both back sides of my head are sticking out. I also wish to reduce the top portion of my head as well to make my head smaller overall. Especially, the back side of the parietal region. 

Here are some specific questions…I am sure you get these questions all the time.

1) What are the risks of the head reshaping surgery? 

2) How much swelling will be expected? Does my head get bigger than before until the swelling goes down?

3) What will happen to the excess skin? Is it possible to cut it off?  Is there any sagging skin issue after?

4) For the top and the side skull reduction how long the incision will be?  

I don’t know how much physical difference you can make. But even 5 to 7mm, I will be

happy. 

Sorry to bother you with many questions. Looking forward to hearing from you.

A: It is very common in my practice to have patients come from all over the world so we are very familiar with this scenario. Far away patients usually come in a day or two before surgery, have the surgery, and return home in 3 to 4 days after this type of surgery. Most do come but themselves which is why they stay overnite in the facility after surgery. Any after surgery followup is done online by email so there is no reason to return for a specific follow-up appointment. It is usually just a one time visit for the combined consultation and surgery.

In regards to skull reshaping, specifically skull reduction, the answer to your question is as follows:

1) The only risk is that there will be an incision (scar) to do the surgery and the question of how much can be reduced. (i.e., can enough be done to make the surgery worthwhile) In that regard you have made a key statement in that if even 5 to 7mms was taken down that would be viewed as an improvement. By that measurement of success, then it would be worthwhile as that is what can be maximally taken down in most areas.

2) There would be some swelling and your head would initially be slightly bigger than when you started. But the swelling is not so significantly different that it makes your head look overly big.

3) There would be no sagging skin afterwards. The scalp skin will shrink down quickly to adapt to the smaller size.

4) To get the maximal reduction of all involved areas, an incision would be needed in the more traditional coronal style, meaning a longer incision from the top of the ear from wide to side. This gives maximal exposure to do the work for the best reduction possible. It is an incision that heals well with a very fine line scar in most cases.

Dr. Barry Eppley

Indianapolis, Indiana