Can I Have Secondary Sagittal Crest Reduction Surgery?

Q: Dr. Eppley, I had one previous surgery along the sagittal suture about one and a half years ago by a german surgeon, but the result was not satisfactory. I am interested in additional bone burring along the sagittal line but more laterally this time. Also The scar in that area has become significantly indented and is about 10 cm long.

Additionally I am considering a slight reduction of the upper forehead by a few millimeters in a small area.

A:Thank you for your inquiry and sending your pictures. That is certainly an impressively large scar by my standards for doing sagittal crest reduction surgery and illustrates  exactly why a midline scalp  incision like that is not a favorable one. However that is the scar that you now have and it can certainly be used for further surgery and revised for a better scar outcome.

The important issue in any form of skull reduction is safety or how thick is the only area in which one what’s reduced. In many sagittal crest skull deformities the thickest part of the bone is the crest and it can become remarkably thin as it goes into the parasagittal area. Does it is important to know before surgery exactly what the thicknesses of bone are in your circled areas to see how much further reduction could be done. This is done by taking your 3-D CT scan and doing color mapping of the bone thicknesses. While this is important in any skull reduction patient it becomes especially relevant in someone who has had prior skull reduction surgery.

One could make the argument that since a scalp scar revision is necessary anyway one may as well remove a few millimeters of bone wherever possible by using the eyeball test in reduction to see how much could be removed. However with modern technology there is no reason not to do her preoperative bone thickness assessment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon