What Type Of Skull Reshaping Do I Need?

Q: Dr. Eppley, I’m very interested in pursuing skull reshaping surgery to fix a congenital defect involving the right side of my skull. For as long as I can remember, it has been both a cosmetic concern and one of comfort. (causing pain/discomfort with prolonged lying on the right side or with wearing helmets of any sort). From reading your web-based article, I believe I may be a good candidate for your procedure. I’ve attached a few photos of the affected area for your review; of course it’s difficult to capture the magnitude and dimensions of the defect (a bulging, sharply angulated defect) with mere photos. I thank you in advance for your time and consideration.

A: As best I can tell from your pictures, the location you are referring to is the right parietal/posterior temporal region. You describe it as a congenital defect but also call it bulging. I suspect you mean a lifelong bulge in this area which is painful. This is very consistent in my experience with more of a temporalis muscle problem in that area. Most patients and even physicians have little appreciation of how thick the temporalis muscle is in that area and how far back it goes. It always feels like bone but there is a 5 to 7mm layer of muscle under exactly where you point. Having done a far number of temporalis muscle reductions/resections (temporal reduction) in this area for symptoms described just like yours, I can attest that your concerns are more likely muscular based than being a bone problem. A CT or MRI will show how thick the muscle is in this area. However, I often make the decision to do muscle resection/reduction based on the description and physical examination only.

Dr. Barry Eppley

Indianapolis, Indiana

How Effective Is Skull Reshaping Surgery?

Q: Dr. Eppley, I’m currently struggling with a flat back of the head and a small head too. Can skull reshaping surgery be done on me to add any implant to mainly the back and top parts of my skull that would give me a decent sized head that is also well rounded ? How effective is this surgical procedure and what are the possible negative effects of any implant on my actual skull?

A: Skull reshaping (augmenting a flat area) can be done to almost any part of the skull and its limits are based on how much the scalp can stretch to accommodate the volume of augmentation. Based on what one’s expectations are, it can be a highly effective procedure. I would have to see some pictures of your head that show the flatness and then do some computer imaging to see if what skull augmentation can do is sufficient. It is always important before surgery to find out if the changes meet a patient’s expectations and to determine how much volume is needed to create that augmented effect.

There are no known long-term effects of the materials used in skull augmentation as it relates to the bone or the overlying scalp tissues. Bone resorption is not known to occur nor is scalp thinning over it.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Get A Minimally Invasive Skull Reshaping Procedure For My Skull Dent?

Q: Dr. Eppley, I am interested in a minor skull reshaping procedure. Can you fix the dent on the right side of my head with relatively minimal invasive surgery? Question 2: I have had the dent as long as I can remember, I’m 42 years young! Is there a formal name for my “condition”? I suspect what we are looking at here is in fact a dent. My only other theory is that my forehead maybe high on my right side thus giving the appearance of a dent toward the back right side? Thank you very much for your time.

A: You at an ideal candidate for a small skull reshaping operation. You do, in fact, have a high forehead dent or groove in the bone. It has no other formal name although it lies parallel or may be over the original coronal skull suture. Thus it may be a malformation of the coronal suture where the two edges of bone come together to fuse. Regardless of its etiology, it can be treated by a minimally invasive cranioplasty procedure. By making a very small scalp incision (less than 1 cm.) the tissues over and around the dent can be elevated. Then through a small tube, a bone cement material can be injected and then smoothed out from the outside as it sets. This could be done under local/IV sedation with really no recovery other than a small amount of swelling. The ‘trick’ to this procedure is to not overfill it and get the entire area smooth and flat. You don’t want to trade off a ridge for a dent.

Dr. Barry Eppley

Indianapolis, Indiana

Can Skull Reshaping Surgery Reduce The Prominence On The Back Of My Head?

Q: Dr. Eppley, I am interested in skull reshaping reduction of the size of the back of my head. For a long time, I have had a distressing issue with the prominence of the back of my head in what I believe to be the occipital bone region. The problem is primarily located slightly right of centre of the back of my head. In other words, from side view, my head sticks out more on the right side than it does on the left and the bone can visibly be felt as thicker and more protruding. It also doesn’t help that my crown area feels very flat and almost leads into a boat shape back of the head. After much research, I do not necessarily believe that I have a form of craniosynostosis, though I am not ruling out the possibility of perhaps a mild manifestation of it.

As a young 25 year-old man, are there options out there for me to possibly reduce the ‘sticking out’ of the back of my head, so that I can have a more ‘normal’, flatter back of the head? I have attached two photos, taken from either side of my head, so that you can notice how one side sticks out more than the other (though my occipital bone in general sticks out much more than normal). I also appreciate that it may be hard to tell by the photos because of my hair coverage, which I keep as an attempt to mask the bumps. I understand that things of this nature are usually dealt with more in children but I came across your site when researching possibilities for occipital reduction.

A: Skull reshaping of the prominent back of the head is very common in my practice. It is never a question of whether occipital bone reduction can be done, it is always a question of whether the reduction achieved will be significant enough to justify the effort. As a general rule, 5 to 7mms of occipital bone can be reduced. That may not sound like much but usually produces a noticeable size reduction. Just based on your description of the problem, it sounds like this amount of reduction would be adequate to make a difference in your back of the head shape.

Dr. Barry Eppley

Indianapolis, Indiana

How Is Skull Reshaping Surgery Done For A Flat Back of The Head?

Q: Dr. Eppley, I am interested in skull reshaping surgery for the back of my head. I have attached some pictures. Although they are a little fuzzy I think you can see the problem. The left is much flatter than the right. Let me know if it is possible to do what I want which is to fix the head shape so that it is more round and therefore more normal in the back on both sides (more on the left than the right.) I also have a few more questions to ask. First of all, are there any long term side effects of the surgery? (not the rare ones but common ones I should know about as I know there are risks with any surgery). Secondly will I need to keep coming back for surgeries in the future (for such things as touch-ups)? Will it affect my hair growth? These are questions I was unable to find out for myself. I hope I have not been too much much of a bother. I am really excited for this as you can see and I really, really appreciate your prompt and helpful responses. Thank you for everything.

A: As skull reshaping surgery goes, your back of the head problem is the most common skull problem that I treat. Flat back of the heads are common and rarely are they perfectly symmetrical. They are corrected by an onlay cranioplasty procedure, most commonly using PMMA as the augmentation material. The surgery is done through a limited 9 to 10 cm incision (no hair is shaved) placed closer to the back of the head through the material is applied and shaped. The only short-term complication (< 6 months) that I have ever seen is aesthetic in nature, how smooth is the applied material and does it give enough of the desired augmentation. If either is observed and bothersome, a touch up procedure may be done to smooth it out or add more material if possible. I have not seen any long-term complications. If one has a satisfactory result by three months after surgery to their own assessment, then no further procedure will ever be needed. Lastly, he procedure does not affect hair growth.

Dr. Barry Eppley

Indianapolis, Indiana

What Can Be Done For A Flat Back Of The Head?

Q: Dr. Eppley, I am very interested in skull reshaping surgery. Since I was young I always thought my head shape was oddly shaped making it unpleasant to cut my hair short, wear hats, or even have different hairstyles. I would like to know how long you have been doing this surgery because a surgery like this can go very right or very wrong unless someone is very experienced in doing it. I know that the same surgery is also done in Korea but I would rather not go so far. I always hoped that a surgery would be able to fix my head shape, I just never knew that there were surgeons out there who could do it. My head is flat in the back and is not even symmetrically flat as one side (the left) is more flat than the other. Please tell me what you think can be done.

A: There are many options in skull reshaping surgery. I would need to see some pictures of your head shape to determine what needs to be done exactly. But by your description it sounds like a case of a flat back of the head (occipital brachcephaly) with some asymmetry to it. Thus the surgical treatment would be augmentative as an onlay cranioplasty approach, probably using PMMA as the material as the volume addition would be at least 60 grams maybe more.

I have done many such skull reshaping surgeries, and many other variations of it, for over 10 years based on a lot of craniofacial plastic surgery and biomaterials experience previously.

Dr. Barry Eppley

Indianapolis, Indiana

Can Skull Reshaping Be Done For The Nuchal Ridge?

Q: Dr. Eppley, I am interested in an unusual form of skull reshaping.  I am currently investigating possible procedures that could change my skull contour. I have congenital skull asymmetry/tilt, and have attached a simple drawing approximating the current shape of my skull. The area I would like to treat is on the left side of my posterior skull/occipital bone. If possible I would like some reduction of the skull near the occipital bone/protuberance and nuchal ridge on that side. In addition to this I would like to increase the volume beneath the ridge with a fat transfer. The goal of this would be to make it appear as if the nuchal ridge was lower on that side than what it actually is. My understanding thus far is that a solid implant would not be suited to this area as it could not be secured and it would have to lie on top of tendons/nerves and I’d prefer a more long lasting treatment over temporary fillers. Assuming there is enough bone that some can be safely removed, what amount (i.e. how many mm) can this part of the skull usually be reduced? I’ve seen photos of fat transfers treating various defects on different parts of the body and am curious how much projection could potentially be possible. The area I would like to increase volume in is roughly 2cm wide and 7cm long with varying depth. The depth would vary up to a max of 1cm. I know that fat transfers are unpredictable and can take multiple sessions, but I’m curious is this would be potentially feasible. My weight is stable and does not fluctuate much. In your estimation would these procedures be technically possible or something that you could potentially perform? I would very much appreciate your input.

Occipital Nuchal Ridge Dr Barry Eppley IndianapolisA: Skull reshaping can be done for a wide variety of bone issues. The area to which you want to reduce is known as the nuchal ridge of the occipital bone. It is actually where the posterior neck muscles attach to the skull. As a result it is very thick to accommodate the pull of these strong neck muscles, illustrating the biologic principle of form following function. This is why it is a raised edge of bone and can be substantially reduced in its prominence by a burring technique. As for augmenting the area below it, fat injections can be done but I would have little confidence that they would create, even if they survive, a raised ridge presence. You would be better served to have an actual implant placed down that low and secured to the bone. Since some of the neck muscle tissues has to be released anyway to do the burring, it would be more reliable to attached a small silicone implant with those dimensions to create an assured permanent ridge effect.

Dr. Barry Eppley

Indianapolis, Indiana

After Skull Reshaping Can One Play Contact Sports?

Q: Dr. Eppley, I am interested in skull reshaping for a flat spot on the back of the head. My son is twelve and has a noticeable flat on the back of the right side of his head. He has not said anything about it yet. In preparation for the possibility of coming to see you, I have an important question. Does getting kryptonite mean he will never be able to play contact sports such as football again?

A: Skull reshaping that involves building out flat or depressed areas is done by applying a bone cement material on the outer aspect of the skull. In answer to your specific question, kryptonite as a cranial augmentation material is no longer available and has not been so since late 2011. In answer to your general question, augmentation of the occiput (back of the head) would in no way preclude one from participating in form of sporting activity including contact sports. The strength of the cranioplasty material up against the rigid skull bone makes for a very hard construct that has the same strength as that of natural skull bone. This makes it highly impact resistant to the infrequent contact to the head that may occur in most sports.

Dr. Barry Eppley

Indianapolis, Indiana

Can Skull Reshaping Surgery Get Rid Of My Prominent Ridge?

Q: Dr. Eppley, I am interested in a skull reshaping. I am a 32 year-old man with an odd-shaped head with a prominent ridge running own the middle. While I could always feel it, it never bothered me until I started to lose my hair. Now I feel like an alien with this visible ridge on my skull. Can it be reduced?

A: Skull reshaping can involve reduction of prominent bony areas or bony buildup of deficiencies. One particular bony skull excess is the sagittal ridge or crest that occurs in the midline of the head. It usually occurs due to a mild anomaly of how the sagittal suture closes after birth. As a result it can develop excessively thickening creating a ridge or crest in the midline of the head that is especially noticeable in men that have short hair or shaved heads.

Because it is a bone protrusion or thickening it can be reduced to a more normal skull contour without risk of exposing the dura or penetrating into the brain. This procedure is done under general anesthesia through an incision placed at the back end of the crest. A scalp flap is elevated exposing the crest that is reduced with the use of a burr creating a smoother upper skull contour. The scalp tissue is closed without use of any drains and only a head dressing is used for the night after surgery after which it can be removed. These small scalp incisions can heal remarkably well.

In summary the sagittal ridge is a midline bone protrusion that can be reduced through a minor skull reshaping procedure using small scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

 

Can Skull Reshaping Surgery Reduce The Bump On The Back Of My Head?

Q: Dr. Eppley, I am interested in skull reshaping of the back of my head. I am 45 years and I have a small spot of protruded ridged edge at the back of my head from birth. I have never been comfortable with it and I wish it could be corrected for a normal round shape back head. I wish to know if/how it could be corrected. If possible, what’s the cost implication and how the duration of the treatment and possible medical implications if any. I have attached some photos for your examination and prompt response, I may send you more pictures if you so request. Thanks.

A: Your head problem could be solved by a minor skull reshaping procedure. Your ‘spot’ or bump of bone on the back of your head is a raised area over your original posterior fontanelle area that you had an an infant. This is a common area of minor skull contour deformities from indentations to raised ridges. Your midline occipital ridge can be reduced by a burring technique through a small incision. This is a one hour procedure done under general anesthesia as an outpatient procedure. There are no medical implications by taking a small amount of the outer cranial table. Other than some temporary swelling and small fine line scar from the incision there are no potential complications.

Dr. Barry Eppley

Indianapolis, Indiana