Can I Get A Custom Skull Implant If I Am On Sterioids for Kidney Disease?

Q: Dr. Eppley, , I have been on corticosteroids for around 20 years due to kidney disease, and I had a kidney transplant 12 years ago. Over time, long-term steroid use has significantly changed the shape and size of my face and head, as shown in the attached photos (age 16 before steroids vs. age 35 now). The facial changes are quite noticeable, but I’m not sure if the change in head size is clearly visible due to the head covering. In reality, my head has noticeably shrunk in a way that feels disproportionate to my body. I’m unsure whether this is due to bone structure changes or loss of muscle and soft tissue. I had considered a custom implant, but my doctor advised against it due to the high risk of infection related to immunosuppression. Would fat grafting to the face or skull be a safer alternative to improve appearance? Or is there any other low-risk option suitable for a kidney transplant patient? Thank you for your time.

A: Under the consideration of immuno suppression, in terms of cranial facial augmentation, whule fat grafting would be considered the least risky treatment approach I would expect that there would be 100% loss of the injected fat, even if you had enough to harvest to do it. Thus, any chance of success requires implant placement. While there is always an increased risk of infection with any surgical procedure on a patient on high-dose chronic steroid use I do not share the opinion that the risk of infection and implant placement makes it an impossible procedure to consider. Of course, there was always going to be some increased risk of infection in an immuno suppressed patient over someone who is not on these medication. But fortunately, the craniofacial area is well vascularized and tips the balance in a tissue bed that is otherwise less than ideal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon