Q: Dr. Eppley, How much volume addition is possible with a single skull implant surgery without a first stage scalp tissueexpander? In your article I read that the maximum addition is about 1.5 cm. A surgeon in Germany, who implants silicone for augmentation, told me that he can add up to 3 cm without using an expander before. In some cases he needs to scrape some mm of the head rind to avoid tension. What’s your opinion? I am really anxious that 1.5cm aren’t enough for me. Many thanks for taking your time.
A: Only by using a full coronal incision (from ear to ear) could more than 1.2 to 1.5 thickness of a skull implant be placed in a single stage procedure. But even a full coronal incision will not permit a 3cm thick skull implant to be placed. And even if it can be placed that is increasing the risks of complications. As an aside I never seen anyone that needs a 3cm thick skull implant. That would make any head too big. For safety sake you have to avoid being too ‘greedy’. It is far better to have 50% to 70% of the result you want that has no complications than 100% of the result that develops a complication. A complication in a skull implant (infection, wound dehiscence) means that the skull implant is coming out and all will be lost.
Dr. Barry Eppley