Can 3D Custom Implants Be Done For Temporal Hollowing?

Q: Dr. Eppley, Do you do temporal implants for people after craniectomy/craniotomy? Or only for those with wasting from other nonsurgical issues. I had a craniectomy after brain surgery after fractured my skull in a car wreck. Despite the severity of the injury I have made a full neurologic recovery.

However the neurosurgery itself caused a massive amount of temporal hollowing. My neurosurgeon for the last year has said I’d be eligible for 3D custom implants. However after waiting a year and consulting with another doctor who is supposed to specialize in 3D custom implants he told me he had only donetwo temporal implants which both had to be removed and would not do them on me. I’m not sure if there was a further scientific based reason for this as my appointment with him only lasted five minutes. He also said he would not recommend me to get the implants done by anyone else. 

I understand these 3D custom implants have been around only shortly since 2013 but I know regular temporal implants have been around for decades. I feel trapped in being disfigured like this and don’t know where to really look for a solution. I’m not sure why my neurosurgeon would recommend me for 3D custom implants for a year and then I’d not be eligible for them or for any cosmetic solution to my temporal hollowing. 

Do you take patients from Canada? I would really be relieved to find a solution to this as Canada does not have many plastic surgeons in total and then even fewer that have dealt with cranioplasty let alone anything with soft tissue replacement implants.

A: I have done temporal implants for years for both aesthetic purposes as well as for reconstruction after neurosurgery due to temporal muscle wasting/detachment. The key factor in success in neurosurgery patients is whether they have had radiation to the temporal region or not. With your trauma history, you clearly have not received temporal irradiation. I can not give you a good reason why two separate surgeons would not do a 3D temporal reconstruction on you. Unless there is something that is not clear to me, I can not envision the circumstances where it is not possible. Can you send me some pictures of your temporal deformity and any CT scans that have been done since your surgery. I know the CT scans may or may be available and are not important right now. If based on your pictures I feel you are a good candidate then we would need a new 3D CT scan anyway.

The success of any craniofacial implant reconstruction is the quality of the overlying soft tissue cover. Adequate thickness and good vascularity of the tissues are important for long term success.

I have patients that come from all over the world and Canadian patients, because of proximity to the U.S.,  are some of the most common international patients I treat.

Dr. Barry Eppley

Indianapolis, Indiana