Q: Dr. Eppley, I hope this finds you well! I learned that my 3D CT scan copy is received and we will be able to move on to implant design process very soon, which is exciting.
At the same time, I was meaning to find out the following, if you may share your input, that would be great.
1. The following link from your blog shows that this case achieved a 15mm-20mm of augmentation, without a 1st stage augmentation involved. Is this amount of augmentation achievable in my surgery?
|Case Study: Flat Back of the Head Correction by Augmentation Cranioplasty – Explore Plastic Surgery – Explore Plastic Surgery – Dr. Barry Eppley – Plastic Surgeon
Background: The shape of the skull is affected by numerous factors including genetics, in utero skull pressures, post delivery head positioning and growth of the brain. In general, the skull has an oblong shape that is slightly wider in the back than the front. While there is no uniform aesthetic standard for a pleasing skull Read More…
2. During the design process, how can we figure out what is the maximal augmentation level that is right below unduly tense (too tight) level while it is at a largest viable stretched amount?
3. For augmentation of the areas on which the head is in contact with a pillow while sleeping, e.g. the back of the head, the sides of the head, what are the chances for the implant be moved or loosened, caused by the weight from my head and neck pressuring on the implant approximately 8 hours a night over many years?
If this is a real concern, can we address to this risk during the design stage?
If implant loosening does occur at some point in the future, due to the weight from the head and neck during sleep, how will we handle it?
4. I highly regard your input in the design process of the implant. I replied Dawn’s email on what surgery outcome I would pursue. Please don’t hesitate to share your advice.
5. After surgery, I may choose to have a shaved head style some point in the future. When there is no any hair bearing for camouflage, will the skull shape still look natural and smooth, especially at the edge area where the implant ends and connects to my original skull area?
What makes a smooth and natural transition at the edge of implant possible?
6. Will the implant cause infection many years after the surgery is done?
7. Is an augmentation implant supposed to last all a life-time long?
If not, in what circumstances does the implant require what form of maintenance in the future?
8. After surgery, will it be ok to receive head massage? E.g. finger pressuring on scalp, which is provided by a regular message therapy store.
9. Will I need an additional revisional surgery? If one is needed, how long after the surgery will this happen?
Thanks for your attention Dr. Eppley : )
A: In answer to his custom skull implant questions:
1) No. That was done with a full open coronal incision which allows for some added expansion due to the mobilization of tissues.
2) There is no exact science as to how to know when the implant is too big or the tissues would be too tight to allow it to be placed and the incision safely closed. My design estimates are based on my experience of placing such implants.
3) Zero. While an understandable question it is never been a postoperative concern., I have never seen a custom skull implant move after surgery.
4) I still need to know what skull areas we are going to cover…back only, front only or both?
5) Due to the feather edging in the design there is a smooth transition from implant to bone.
6) No. Infection risks are in the perioperative period. (up two three months after surgery) Once last this time period the infection risk is negligible.
7) Custom skull implants are made of a solid silicone material which will never degrade or breakdown…thus no need for future replacement due to material failure.
8) Head massages are not needed or advised after surgery.
9) Revisional skull implant surgery would only be needed if you determine you want a bigger implant or a different design later. This is not done until six months after the initial surgery.
Dr. Barry Eppley