Are My Skull Augmentation Goals Achievable?

Q: Dr. Eppley, my head is narrow at the sides, it lacks height and the shape of the skull is smaller. The back is flat with no volume. No overall roundness or volume. I would like my narrow volumeless and small forehead to be more masculine, what’s your outlook on it? What procedure is the best in my case? 

Goals: Skull 💀 Taller head, wide at side, Round back of the head sticking out, overall round with volume. 

A: The key questions in any skull augmentation patient are; 1) What are the zones of the skull that need to be covered (there are 5 – forehead, top, back and sides(2)) and 2) with how much volume for each area? (the maximum immediate volume that can be placed is 150ccs) While on the computer any extent and size of custom skull implant can be designed, that does not mean it can be successfully placed given the constraints of the tightness of the overlying scalp. The basic principle is the more skull areas that are covered the less each area can be in thickness due to the flexibility of the scalp. This is why in larger surface area skull implant coverages or in subtotal  skull implants that are fairly thick, a first stage scalp expansion must be done.

Given some of the examples of skull implant designs you have shown and in your side view drawing these suggest that you would require a first stage scalp expansion to come close to your aesthetic goals. 

To help you think about this clearly you need to answer and prioritize these questions:

1) What are the skull zones that need to be covered and what is their order of priority? You have really described a total overage skull implant of all zones.

2) Can you sacrifice implant volumes to avoid a first stage scalp expansion.

Dr. Barry Eppley

Indianapolis, Indian