Can Head Augmentation Be Done with Tri Calcium Phosphate (TCP) Material?

Q: Dr. Eppley, Interested in head augmentation. Sides are concave and right more than left. Back of head is flat with no projection.

I prefer B-TCP for safety + bone integration. Priority is natural shape + strong fixation.

No CT or measurements yet – I’d like to come for consultation so you can assess me. Hoping it can be kept as simple as possible.

Do you recommend sides + back in one surgery or split?

Thank you.

A:Thank you for your inquiry and sending your pictures. Just based on your description I can provide you with some initial comments and insights.

1) The use of tricalcium phosphate (TCP)  or any other form of hydroxyapatite bone cement for skull augmentation is problematic in many ways which include:

      a) It would require a full bicoronal scalp incision from ear to ear to place since it requires an open field that is completely dry to shape and set up

      b) The cost of such cements are extremely expensive in the volume needed to do the back of head alone and would have a material cost of at least $25,000 which does not include any other costs of the surgery.

      c) Bone cement cannot be used on the side of the head since this is covered by muscle and the material must be placed on bone.

      d) You can now appreciate that it takes a very motivated patient to consider this form of skull augmentation even though it does have a biologic appeal to it. The question is not whether it can be done but whether it is a viable economic option for the patient.

      e) In addition custom made skull implants from the patient’s 3-D CT scan also offers a better aesthetic outcome with more shape and volume.

2)  it is common to perform multiple areas of skull augmentation during the same surgery.

3) I don’t know what the statement ‘hoping it can be kept as simple as possible’ means.

Dr. Barry Eppley

Plastic Surgeon