Can Forehead Reduction and Back of the Head Augmentation Be Done At The Same Time?

Q: Dr. Eppley,I had a consultation with you about 5 years ago, and I’d like to follow up about a specific cranial contour plan. I’m interested in reducing or shaving down the frontal sides of my forehead (the areas that slightly protrude) and then adding volume to the back of my head to create a smoother, more balanced overall shape. Could you please let me know if this combination can be done in one procedure, and whether the occipital augmentation would be with a custom PEEK implant? 

A:Good to hear from you again from five years ago. To specifically answer your skull reshaping questions:

1) the combination of side of the forehead reduction with occipital augmentation would be done as a combined single operation.

2) all forms of aesthetic head augmentation are done by the 3-D design skull implants. Almost all of these are composed of a solid silicone material as that offers the most precise design with feathered edges that can be placed with the smallest scalp incision. That feels just like bone when it is placed on bone. Custom PEEK is not a material that is FDA approved in the United States for any form of aesthetic craniofacial augmentation per the manufacturers. This is a different story in Europe and other places in the world. But even if it was available in the United States the cost to manufacture it would be four times higher than silicone and it would require a complete coronal scalp incision from ear to ear to place due to its inflexible construct. But even if f all of that was not a problem for the patient I still would not use it as it is not possible to manufacture PEEK with super fine feathered edges which is extremely important in skull augmentation as any rounded edges are eventually going to be felt in the shaved head patient are going to be seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon