Am I Too Old To Have Forehead Reshaping From My Plagiocephaly Skull Shape?

Q: I am looking into bone recontouring for my forehead. I am 22 and I have a condition called Plagiocephaly that I have become aware of within the last few years. I have been to three different doctors who have all told me that they believe the condition is “minor” and doesn’t need any treatment. Not only does one side of the back of my head protrude outward more than the other side, but my forehead also does the same thing on the same side that my head protrudes. My brow ridge seems to be fine, but the bony part of the orbital socket (the part the eyebrow itself covers) seems to protrude more than the other orbital socket. It makes my forehead look very uneven. There also seems to be a flat spot on the side of my head right around my forehead region. I would like to know if this is fixable whether it be just fixing the forehead or fixing both the forehead and the back part of my head, but I also want it to look as natural as possible. Basically, I want it to look as close to what it should’ve been without Plagiocephaly. On a side note, I was also wondering why this condition has become noticable to not only me, but others as well, recently. Up until I was around 19 or 20, I had never heard anyone say anything about this to me, but it has become very apparent now. I understand that it has been like this since I was a baby, but I am wondering why it has become so apparent recently. Is it because the forehead hadn’t fully developed yet and thus became more distorted to the point of noticeability by the time I turned into my late teens to early twenties?

A: Plagiocephaly, known as a twisted skull, is a deformational skull shape that occurs in infants,  evident either at birth or developing thereafter. Most commonly, it is the result of preferentially laying one side of the back of the head. Since the skull is very thin in infants, it can easily be inadvertently molded into an abnormal shape. That shape pattern is classic and you have described it perfectly.The side of the back of the head which is flat will cause the forehead on the same side to protrude. If significant enough, the shape of the eye (orbit) can also be affected.

What to do with this skull shape in an adult is a difficult problem. The bone is very thick and reshaping it is a major undertaking with long scalp scars. I would leave the back of the head flattening alone as the effort is not worth the result in most cases. The more visible front, the forehead, however, may be worthy of cranial reconstruction surgery (forehead reshaping) if severe enough. I would need to see photos to determine how severe it is and whether any surgery and its benefits is worth the risks. The biggest issue in forehead reshaping is whether a scalp scar is worth the trade-off.

The shape of your skull and forehead was determined long before you were fully developed. I do not think that it is more apparent now because it developed in your teens. I think it is more likely it has become apparent and now is a focus, making it seem it wasn’t there before.

Dr. Barry Eppley

Indianapolis, Indiana