Can My Depressed Craniotomy Bone Flap Be Built Up So My Forehead Is Smooth?

Q: Dr. Eppley, I am a 24 year old male. Seven years ago I was diagnosed with a right frontal lobe tumor and underwent craniotomy. The procedure went well and all has healed medically well. However the bone flap due to the nature of the cutting process sits slightly lower than my normal skull. Not by a huge amount but about 2-3mm at the most, but is noticeable. I am wondering if cranioplasty can be performed to build a couple millimeters on the flap and thus smooth the forehead/skull? I already have an incision scar in the hair bearing area which starts in the top centre of the forehead and extends to just behind/above the right ear. I presume this can be re-opened. The bone flap is fairly well aligned just above the ear, but towards the top and front, slightly lower. It is the step in the visible part of the forehead which is of most significant in improving. Can you able to advise on possibility, risks, and estimated costs? Much appreciated.

A: An onlay frontal cranioplasty will solve the forehead contour problem of your bone flap very successfully. Using your old scar, the area to be augmented can be easily accessed and built up. While there are a variety of cranioplasty materials to use, and that selection affects costs, I would  prefer to use an hydroxyapatite paste material which hardens shortly after application. That would be the most ‘natural’ material to use that would serve you best over your long remaining lifetime. This would be a one hour procedure done under general anesthesia and the estimated total costs would be in the $7500 to $8500 range.

Dr. Barry Eppley

Indianapolis, Indiana