Can I Reshape My Head With Bone Cement?
Q: Dr. Eppley, Hello. I want to reshape my head with bone cement. The first image is before and the 2nd is what I would like (used photoshop). Is this possible?
A: You are not going to get that skull augmentation result (or even close) with bone cements for the following reasons:
1) The most common bone cement (PMMA) used in the skull is a plastic material and does not turn into bone. It is in fact a plastic implant so don’t let the name mislead you. It is the same material that is used to cement in orthopedic joint replacements. When used in the skull the manufacturer simply puts it in a different package and calls it Cranioplast.
2) The other type of bone cement (HA or hydroxyapatite) is a synthetic phosphate (ceramic) that does not turn into bone either. It may be a distant cousin to bone but is still an implant. It was developed for the use in cranial defects (inlay) not onlay (on top of the bone) augmentation. While it can be used for small skull augmentations, it is too brittle to do large ones. Of equal importance its cost precludes its use for most aesthetic patients. At over $100 per gram the cost of the material alone (large skull augmentations are in the range of 150 to 200 grams or greater) would be in the range of $20,000.
3) Even if #1 and #2 were not issues with bone cements for skull augmentation, they require wide open exposure for placement which means a full coronal (ear to ear) scalp incision is needed.
4) Bone cements can only be placed on bone and can not be applied over soft tissues areas. (side of the head) The larger a skull augmentation is (more projection) the more its base needs to be wider and cover more surface area so the result does not look like an unnatural bump on the head. This means the augmentation has to wrap around onto the sides of the head which are soft tissue covered (temporalis muscle and fascia) onto which bone cements can not be applied. (will not stick to it)
In summary bone cements have a very limited role in aesthetic skull augmentations and only have merit in small skull augmentations that are usually in the 50 to 60 gram volume….a result that is a far cry from the one shown in your own skull augmentation imaging.
Dr. Barry Eppley