Q: Dr. Eppley, I am interested in occipital augmentation. The back of my head looks exactly like the picture that I have attached and the issue is the protruding occipital bun at the back of the head of which I am concerned. However my skull is quite small or a man (22.5 inches circumference) and I do not want to reduce it anymore than it already is. I was doing some computer morphing and I found that the result that I want can be obtained (on the morph) by augmenting the area at the bottom of the back of the head (the concave curvature underneath the occipital bone to the neck). I understand that the area is complex and that it is partly muscular. Is there any way to augment this area either by custom implants, custom soft tissue implants (similar to those used for temporal augmentation), fat transfer, fillers etc.?
A: As you have correctly perceived, the area on the back of the head that you are interested in augmenting is not a bony structure. Unknown to most people is that the bottom edge of the occipital bone sits at above the level of a horizontal line drawn across the top of the ears. There is no effective way to do occipital augmentation in what is essentially the top part of the back of the neck. This is tight skin over muscle with little fat in the subcutaneous plane. Neither an implant, fat transfer or any synthetic filler can provide any significant augmentation in this non-skull area.
Dr. Barry Eppley