Q: Dr. Eppley, I am interested in a custom skull implant. I have a strange depression across the top and back of my head. Fortunately as a women my hair can hide it. But I do occasionally like wearing my hair short and then it becomes apparent. I have attached pictures with my head nearly shaved so you can see it. Would a custom skull implant work for this type of skull shape problem?
A: Thank you of your inquiry and sending all the well done pictures and videos. It can be seen in the pictures almost the exact outline of a custom skull implant that would be used to augment all of the depressed skull areas. (back of the head, posterior fontanelle dimple and parasagittal areas. While the design and fabrication of such a custom skull implant can be done from a 3D CT scan, we have to consider the following issues in its design:
1) How much back of the head augmentation can be achieved give the amount of scalp stretch that can be achieved in a one-stage procedure. (this is usually in the range of 10 to 12 mm at the central area of greatest project in the back)
2) The incision used to placed the implant. Ideally I usually like to use a low occipital horizontal hairline incision as opposed to anything across the top of the head. This usually allows the incision to be smaller in length also.
3) The location of the incision and its extent plays a role in whether the parietal region can be accessed for reduction. This is really the single greatest issue as providing access to do the parietal reduction may make an incision longer than may be aesthetically tolerable.
Dr. Barry Eppley