Can The Skull Bulge Above My Right Ear Be Reduced?

Q: Dr. Eppley, I have visited your website and am aware you do skull reshaping surgery. I was wondering if you could review the attached picture and can you notify me on what could be done for a skull bulge on one side that is just above my right ear.

A: The bulge to which you have shown is the temporal area which is composed of more muscle than bone. That can be very effectively reduced through a small vertical temporal incision, shortening the thickness of the muscle and reducing the bone a bit. I have done that type of skull reduction successfully numerous times. It is a short one hour procedure done under anesthesia. There is very minimal pain afterwards, no real recovery other than a little bit of swelling after surgery, and no physical restrictions afterward. It does result in a very fine vertical scalp scar measuring about 3.5 cms in the hairline.

Dr. Barry Eppley

Indianapolis,Indiana

Can My Big Head Be Made Smaller?

Q: Dr. Eppley, I’m 18 and 5’6 tall and weight 130. I was born with a big head. I’m so insecure about myself seeing everyone around me with a smaller head makes me depressed. I’m planning on having a

head reduction if that even exists?? The top of my head is wide and long.I have a perfect idea on what parts of my skull can be removed in order for my head to look smaller. I’m also thinking that maybe my jaw makes my head look big as well so I’m guessing you could probably help me out?

A:  One of the first realities is that the concept of a skull reduction for an overall larger head is limited. It is simply not possible to make a big head much smaller. So there are limits as to how much the skull can be reduced. Your statement that your jaw makes your head look big suggests that your jaw is small. Making a small bigger is a much more realistic goal. I would need to see pictures of your face/head to determine what, if anything, can be done to improve your perception of a skull-face disproportion.

Dr. Barry Eppley

Indianapolis,Indiana

Does Skull Reduction Make It Prone To Fracture More Easily?

Q: Dr. Eppley, I have seen that you offer skull reshaping. You said that the maximum that can be reduced is 5 to 7 mm. My question is, will that be enough to make a difference in someone who has a big head? I mean, a visual difference. Would it make a difference also when buying hats and sunglasses? I don’t expect a huge reduction, but I am just figuring out how much of a visual improvement I could expect. Lastly, if you take out the outer table of the skull, doesn’t it make it more susceptible to fractures? I would be scared to bump my head and injure my brain. Thanks

A: It many cases it can be surprising how much of a difference 5 to 7mms in skull reduction creates when done on a near circumferential manner. Given that the skull thickness ranges anywhere from 12 to 20mms

depending upon the location, there is no danger of increased susceptibility to skull fracture after a burring reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Can The Sides Of My Head Which Stick Out Be Reduced?

Q: Dr. Eppley, I have been bullied for a number of years over the shape of my skull and I am looking to do something about it as it’s ruining my life. The width is an abnormal shape and above the ears it sticks out quite a bit. I have read some of the questions on the website and seen Doctor Eppley’s answers which seem like it would be something that can assist me. Am I right in saying Doctor Eppley is the only person in the world who performs skull reduction surgery? I have spoken briefly with someone over email where I live but I am not sure the procedure they suggested is what I am looking for. I need to find the right procedure as I feel  it is a necessity to have it done to be able to enjoy my life at all. I’m so depressed about it and I’m really searching for someone to help me before I get myself in to a bigger hole with the depression.

I have attached a picture. Are you able to say whether I can be helped or not please?

How long would I need to be in hospital for and when could I travel back home?

I’m worried about the strength of my skull after the surgery, I will be able to live a normal life afterwards won’t I, like play football etc??

I really appreciate your help and you taking the time to read this I understand you are very busy. Another question is that my ears are quite pointy/large and if I was to undertake this surgery I’m worried they will stick out even more, can anything be done with them so this doesn’t happen and they look a bit more normal?

I’m so sorry for so many questions. Whereabouts on my head would the incisions be? Would they be behind the ears and would they be quite deep scars?

I had thought about hair transplants at some point in the future because my hair seems to be disappearing rather quickly but I do prefer the shaved look if I’m honest. Do you think this would be a major problem?

I have to admit it has put a smile on my face knowing that you can possibly help. From the picture do you think the 5mm-7mm you mention in your questions section on the website will be enough to make my head look more normal in terms of shape?

Thank you so much for getting back to me.

A: Thank you for your inquiry and sending your pictures. From what I can see in this one picture (which is the most helpful view), there is temporal skull/muscle protrusion as well as ears that stick out a bit. This could be improved by a combination temporal muscle/bone reduction cranioplasty combined with a setback otoplasty.

This is a procedure that is done as an outpatient and one could return home in 48 hours. There would be no worries about the strength of your skull and you would not have any restrictions after surgery.

The most relevant issue is that an incision is needed on both sides to do the surgery and this is always a concern when it is a male who shaves his head or a has a close cropped hairstyle. We just have to be careful to not ‘trade-off one problem for another’.

To be certain we are looking at the same thing, I have done some before and after imaging to see if the changes that are possible is in line with what your objectives are. This is probably what a 5 to 7mm reduction can achieve.

The incisions would be vertical in the hairline just behind the ears and extending upward about 6 to 7 cms. They are not deep or indented scars but rather just fine lines.

Dr. Barry Eppley

Indianapolis,Indiana

How Much Skull Reduction Can Be Done?

Q: Dr. Eppley, I have a pituitary tumor that made my skull grow very big. The pituitary tumor has been removed now and I am cured and cleared by my doctors. But the size of my skull is too big and very bothersome to me. It is very negatively impacting my self-image. My skull is too high up top and slopes down in the back. The temporal areas also stick out too far. How much skull reduction can be done to help me?

A: What I can tell you, with a lot of skull surgery experience, is that you can’t go deeper than the outer cranial table which often is anywhere from 5 to 7mms thick. Yours may or may not be thicker than that is some areas. At that point you enter the diploic space where a lot of bleeding occurs and the inner cranial table is not much further away. That is the limit of safety for any skull reduction procedure.

While 7mms may not sound like a lot of reduction, when done in a lot of areas of the skull, the external or visible appearance can be a lot more significant than the number sounds. It is common that patients think they need a lot more skull thickness reduction than they really do. I didn’t say that such a skull reduction result would be perfect or ever as much as some patients want. But is usually enough that patients feel it made a real difference.

Dr. Barry Eppley

Indianapolis,Indiana

Are My Skull Reduction Drawings Realistic?

Q: Dr. Eppley, I have a question regarding skull-shaping. I have a bump on the top of my head and the back of my head sticks out way too much. I am hoping to get these areas reduced so that my skull would have a more round shape. I want to know if this amount of skull reduction would be possible at all. Here's a picture to show you what I'm thinking, not necessarily the exact way I did it but something along those lines, what would be realistic?

A: Thank you for your inquiry. The areas of the skull that you show you want reduced can be reduced,

it is just a question of magnitude. Generally speaking up to 5mms of outer table skull thickness can be reduced in most patients. Probably what you are showing is a little more than that so exactly what you are showing is not realistic But I have seen some signficant external changes occur when only 5mms is reduced, particularly when two skull areas are being reduced. That amount of skull reduction may not sound like much but often is more visible from the outside than what that number may seem.

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Would Having A Prior Hair Transplant Preclude Having A Skull Reduction Procedure?

Q: Dr. Eppley, I want to get the prominence of the back of my head reduced but I have previously had hair transplants done over six years ago. Will this prevent me from having the skull reduction procedure?

A: That is a very good question. I will assume that you have a linear occipital harvest scar now. about in the middle or lower end of the back of the head. This would be the typical location for a traditional hair transp

lant harvest siteIf one was trying to do an augmentation, having had an occipital harvest site would be problematic and would preclude it. But for an occipital reduction it does not. Depending upon the exact scar location, it may be able to be used for the skull reshaping reduction. and its presence would be fortuitous.

Dr. Barry Eppley

Indianapolis, Indiana

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How Much Can My Skull Be Reduced?

Q: Dr. Eppley, Is it possible to reduce the size of a skull/head when it is too big? My head has a circumference of 23.6 inch/60cm. I have attached pictures of where I would reduce the skull to give it a better shape.

A: Thank you for sending the computer imaging showing the areas of your skull you would like reduced. These images make it very clear your areas of concern and I will define these as three skull areas. First, on the low back of the head is the prominence known as the nuchal line. This is a naturally raised area in many people because it serves as the attachment of the neck musculature to the back of the skull. This is why it is thicker and raised. Second, there is a prominence in the bi-occipital width as seen in the front view. Lastly, there is a midline ridge on the top of the skull known as the sagittal line that is prominent giving your skull a bit of a peaked appearance.

Based on these locations and the amount of skull reduction you have shown in the images, I think that is a very achieveable aesthetic change with burring reduction in all areas. The key question is the need for an incision to get there to do it. Given that you are a male with a close shaven head, this is a serious aesthetic consideration. There are two fundamental approaches. A limited posterior scalp incision that will good access to the back of head for nuchal line and bi-occipital width reduction but a more limited reduction of the midline ridge due to the curved surface of the skull and how far the ridge goes frontally. Good access could be obtained to all areas with a full bicoronal incision but that is less desirous in a man with a shaved head.

Dr. Barry Eppley

Indianapolis, Indiana

Does Skull Reduction Make The Skull Weaker?

Q: Dr. Eppley, I googled “skull reduction” and found out that you are the only one in the world who does skull reduction. I see you need a bicoronal incision for this, which is not a problem. I have a big head and can’t wear hats and I am always teased. I read that reduction is achieved throught a rotatory instrument that shaves done the external layer. You said to think about an oreo cookie. When do you reduce the skull, do you only use this instrument or you do osteotomies as well? If you burr the bone doesn’t the skull become weaker and more susceptible to fractures or soft to the touch? Do you perform a lot of these procedures?

A:  In answer to your questions:

1) Cosmetic skull reduction is done by burring down the bone,, not by osteotomies. Osteotomies are major cranial bone flaps are not indicated for cosmetic improvement.

2) The skull does not get appreciably weaker with outer cranial table reduction as there remains an inner diploic layer as well as an inner cortical bone layer as well to the skull.

3) Various forms of skull reduction/reshaping are done in my practice. Whether anyone is a reasonable candidate depends on many factors and I would have to seem some pictures of one’s head to determine if they are a reasonable candidate.

Dr. Barry Eppley

Indianapolis, Indiana

Can The Back Of My Head Be Reduced?

Q: Dr. Eppley, I have a very large head that sticks out in the back (about one inch), is pointy on top, and comes out on each top-corner as well. This has caused me much mental distress ever since I was a chiold, and now that I am in my late twenties, and my hairline has receded a bit, I am noticing it even more. I am unable to wear most hats becuase they do not fit. I am wondering what sort of optiond I have to reshape/reduce my skull size. I don’t think there is anything that can be done to make it completely normal, but anything would be better than what it currently lokos like. I would appreciate any feedback you can give me. I have a few specific questions that I hope you can answer.

  1. As an African-Americn man that wears relatively short hair cuts, I ama concerned about having a large scar across the back of my skull. Are there any other otpions that would work equallya s well as an open procedure?
  2. What are the general costs for the procedure i m requesting?
  3. If an open procedure were to be done, how long of a scar would it be?
  4. If an open procedure were to be done, what happens to the excess scalp skin? is it removed as part of the procedure?

A: Since I have not seen your particular skull problem, I can only provide some general answers. The question will come down to…can the back of the skull be reduced enough to justify an occipital reduction cranioplasty surgery by burring? That will ultimately require a plain skull film from the side view to take a measurement and see how much can safely be removed.

To answer your specific questions:

1) No.

2) Probably in the range of $6500 to $8500.

3) 10 cms. (4.5 inches)

4) A little maybe, although it usually shrinks back down.

Dr. Barry Eppley

Indianapolis, Indiana