Nuchal Ridge Skull Reduction
Q: Dr. Eppley, We have already had a very informative Skype discussion about a possible nuchal ridge skull reduction at the back of my head with occipital implant above it. I think you suggested that the scar may be in the region of 7 to 9cms in length. I spend a lot of time on your excellent website and am certainly impressed by some of the outcomes relating to skull cosmetic work. The one thing thing which is causing me trouble and keeping me awake at night is the prominence of the residual scar. I intend to have my hair very short, but not fully shaved and keep imagining a visible white line across the back of my head where hair won’t grow.
I know most of your pictures on the website can only really be taken before and immediately afterwards, but it is the medium (several weeks) and long term view (months/yrs) that I would really like to get a handle on. Would you have any images you would be able to share with me?, or alternatively, I see many men on your website who have had similar procedures in a similar context (v. short hair) – would it be possible to ask to forward my details to some of them in the hope they could provide insights into how their scars have settled down?
I accept that their will be a trade off when undertaking a procedure like this, but at the moment my view is not as informed as I would like.
A: Like all patients, particularly men, the issues of scars on the scalp is a major aesthetic concern and consideration in doing any skull reshaping procedure such as nuchal ridge skull reduction. This is particulalry paramount in men that shave their head or have very closely cropped hairstyles. Since I almost never see any patients long-term and men are particularly private about their aesthetic surgery, the information you request is not obtainable. On the positive side, the fact that I have never had a scar complaint or performed a secondary surgery just for the revision of a scalp scar speaks to the general issue that it has not been a poor aesthetic trade-off.
However, the reality of scar concerns in any surgery is that what happens in one patient or lots of other patients is no guarantee that your scalp scar may turn out just as favorable or not of a postoperative concern. Therefore, I have a simple strategy for how to approach the uncertain nature of how scars will turn out in aesthetic surgery and whether one should proceed with surgery. When there is any doubt or apprehension….don’t do it. One should only press forward when they have the attitude that however the scar turns out, its trade-off is more acceptable than the problem they currently have. When a patient tells me they are so concerned about the appearance of the residual scar that it ‘keeps them up at night’, they are not a good candidate for the surgery.
You may think that with more education about the scar, you could make a better decision. But that is actually incorrect and even misleading. One happens on on patient does not always translate to another. Scars are both trade-offs and gambles, one has to have the attitude of ‘rolling the dice’ is worth it for the other benefits of the surgery.
Dr. Barry Eppley