Skull Reshaping

Q: Dr. Eppley, I would like to see the possibilities of skull reshaping surgery. I am 33 years old and have always been unhappy with the shape of my head. My head is big overall and I dislike the unusual shape and so I would like to change this for it to look more normal.  I have the following concerns about my head shape: (1) It slopes down and stands tall at the back side. (2) I have a protruding knob on the back. (3) it’s wide on the sides. So please look at the pictures I have attached.

A: Than you for your inquiry and sending your pictures. I can certainly see your skull shape concerns with a very convex posterior temporal region which connects with an occipital protrusion and a higher posterior sagittal region. All three of these skull areas are really connected and part of the overall skull shape protrusion. While I think there is no question some major improvements on your shape can be made by bone and muscle reduction, it will require a full coronal scalp incision to do so. In a male with your close cropped hairstyle that always give me pause. Every aesthetic surgery involves tradeoffs and one has to evaluate the scar vs. the skull shape benefits very carefully. You never want to trade into another ‘problem’ that you may dislike just as much as what it was designed to treat.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reshaping

Q: Dr. Eppley,  I am interested in skull reshaping surgery. As you are probably aware, healthcare over in the UK is pretty much free. Cosmetic surgery is not given for free due to the fact its simply cosmetic, something you don’t like the look of on your body. If it is present from birth or is causing psychological effects, it can be done for free. I have had a very flathead from birth and it is causing me all sorts of stress and depression. Do you think the NHS (National Health Service) in the UK can provide me with help? Have you heard of anyone getting this type of surgery in the UK through the NHS?  Also whom would you recommend that I go to for skull rehaping surgery in the UK?

A: I have had this question from patients from the UK many times. The simple answer is that there is no surgeon in the UK or Europe that performs these types of skull rehaping surgeries. And even if there were, NHS would consider this a cosmetic surgery just like all insurers do in the U.S.. Reconstructive skull surgery is for the restoration of skull contours for partial or full thickness bone defects. Aesthetic skull reshaping are a collection of cosmetic procedures whose purpose is to change the shape or contours of a skull that have adequate bone thickness.

Dr. Barry Eppley

Indianapolis, Indiana

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, I am inquiring about skull reshaping surgery. In my opinion I’ve got quite a bit to do on my skull as I guess about 60% of my skull needs filler. My head slopes down from the centre of my skull on the top of my head to the back of my head. Also from the back of my head to my ears has flat spots and low spots that need to be filled on both sides. On both sides of my head above my ears is needs to be filled as it  slopes abit to the top centre of my head. Hope this makes sense. I can draw pictures If that helps or a Ct scan might be needed. Also I live in the  United Kingdom which would mean I would have to fly over. Would that have any effect on having the operation then having to return to the UK?

A: From your pictures, I can clearly see your skull shape concerns which are located onj the back half of your head. I would not think that the skull area involved is as much as 60% surface of your head (probably closer to 1/3) but that is a moto point. Your skull reshaping needs could only be done by a custom skull implant procedure. That is the best way to smoothly and evenly augment your skull contour issues. That requires a 3D CT scan from which the actual implant is made through a computer design process.

I have many patients from the UK for a variety of procedures including various forms of skull reshaping. There are no adverse effects from air travel on this type of aesthetic skull procedure.

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 Reshaping

Q: Dr. Eppley, I am interested in skull reshaping as well as jawline reshaping. Would insurance cover my surgery since it is due to congenital plagiocephaly? Also, any doctor in my area that you know of that could do the same surgery that I need? Thank you for everything you do.

A: Thank you for your inquiry. In answer to your questions:

1) It would be impossible to answer any of your questions without knowing what exact procedures that you need. What I could envision what they may be, I would need to see pictures of your face and a more specific description of the skull and facial asymmetries that you have. Skull reshaping and jawline reshaping are broad terms that apply to a variety of different procedures.

2) Only the insurance company can say whether any of the proposed procedures would be covered. To make that determination the treating physician would have to file a predetermination letter complete with a 3D CT scan (to show the deformities) so they can pass judgment on the operative plan. At best, it would be a 50% or less chance that they would cover any of the procedures.

3) Without knowing the exact problem and the needed procedures, I could not say what expertise exists in your geographic area. Skull reshaping and jawline reshaping are very specialized areas in plastic surgery that very few plastic surgeons do.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reshaping

Q: Dr. Eppley, I am interesting in a skull reshaping procedure for a flat side to the back of my head. In my pictures you can see the difference between the two sides of the back of my head. I want to see if you could make the smaller side of my head (left side) look the same as the bigger side (right side). My ear on the flatter side also sticks out nore. Even though it would cause me to have a large looking skull I wish to find a sense of normalness.

A: Thank you for sending your pictures. You have a classic case of plagiocephaly with left occipital flattening and contralateral right frontal flattening. (cranioscoliosis) The skull reshaping treatment for it is an occipital augmentation on the flatter side. The protrusive ear can be set back in a more traditional setback otoplasty with conchs-mastoid sutures. I assume when you mean ‘make the smaller left side of my head look the same as the bigger right side’ you are referring to using a standard/semi-custom implant or bone cement to do so. I think I would use one of my preformed occipital implants that I use for plagiocephaly cases. It is not as perfect as a truly made custom implant from a 3D CT scan but it can make for a major improvement and lowers the cost of this skull reshaping surgery somewhat.

Dr. Barry Eppley

Indianapolis, Indiana

Skull Reshaping

Q: Dr. Eppley, I may be interested in skull reshaping surgery. I am contacting you because I have been searching for a professional opinion relating to some worries I have concerning the shape of my head, and I thought that you might be able to help. I have noticed that there is a clear ridge sloping outwards, and above that, the shape seems to be flatter than when compared to many other people I have seen. 

I never used to be so preoccupied, but this changed when I recently saw my head in profile. I have begun thinking that it is not ‘standard’, and I’ve been wondering whether there may be a reason for this.  

I believe that some attitudes of people towards me, in the past, have been influenced by its shape. Do you think that undertaking cosmetic surgery to correct this would be possible/advisable, based on the images provided?

I realize it’s probably nothing, but I think it’s best to be certain about something like this. 

A: I can tell you whether your skull shape should be a concern to you or not, that is a personal judgment. Beauty is in the eye of the beholder so speak…in this case an abnormality is also.

What I do see is a skull shape that has a flat occiput which has resulted in the posterior sagittal ridge area being raised up and sloping downwards toward the forehead. These skull shape issues are all interconnected and they are a well known type of skull abnormality.

Whether this skull shape should be of concern to you and whether it should be corrected is a personal and aesthetic judgement on your behalf. But it can be done through aesthetic skull reshaping surgery.

Dr. Barry Eppley

Indianapolis, Indiana

How Is Occipital Bone Reduction Done?

Q: Dr. Eppley, I am a 33 year old male and am interested in skull reshaping of the back of my head. (occipital bone reduction) My occipital bone has always been really noticeable. Now I am quite bald it’s even more noticeable now. I often get remarks about it, people tend to touch the back of head to feel it, and I’ve heard people talking about it behind my back. Is it possible to reduce it? I’ve seen a similar case on your webpage.

A: The occipital bone prominence can definitely be reduced. It is only a question of how much and that would be based on the bilaminar thickness of the occipital bone.This is best determined by a simple lateral skull x-ray which will show its entire thickness and the thickness of the outer cortical table of the bone. A tracing of the occipital profile can be done on the x-rays to show what the realistic outcome would be from the procedure in the profile view.

The horizontal prominence of the occipital bone is a very common skull reshaping surgery in my experience. It involves making a small horizontal incision on the back of the head from which the occipital bone is burred down as much as possible. It is usually not possible to over reduce or due too much of an occipital bone reduction.

Dr. Barry Eppley

Indianapolis, Indiana

What Type Of Skull Reshaping Procedure Do I Need?

Q: Dr. Eppley, I was reading the information over skull reshaping in the site and I noticed that the procedures for narrow skulls are usually done with infants or toddlers but my question is if it were anything that could possibly be done to a 20 year male skull? My skull isn’t exactly large but very narrow and long.the reason I’m asking this question although I am aware that this procedure is most common for toddlers is because I research a few before and after pictures on give and I noticed that some of the males appear to be in their mid 30’s or so. I’m praying that anything could be removed or reduced from the front or back of my skull to make it appear at least close to normal if I am fortunate enough to have this procedure done. Please feel free to contact me anytime of the day. Thank you

A: While the most common treatment for a congenital long and narrow skull is complete calvarial remodeling or suturectomy of the sagittal suture, that is for the infant condition known as sagittal craniosynostosis. That type of surgical approach has nothing to do with treating a long and narrow skull in an adult. Such treatments can only focus on camouflage efforts on the outside as the brain is no longer growing and occupies a fixed space on the inside of the cranial ‘box’. Whether these adult efforts at skull reshaping can be done with frontal and occipital bone reduction (which is limited) and/or widening in between the front and the back awaits analysis of your skull shape. PLease send me some pictures of your head at your convenience.

Dr. Barry Eppley

Indianapolis, Indiana