Can My Skull Indentation (Dimple) Be Treated With An Injectable Cranioplasty?

Q: Dr. Eppley, I am 48 years old and have thinning hair on top to the point of shaving it all off. Unfortunately, I would describe my skull as having an embarrassing mild case of some type of craniosynostosis. In simplest layman’s terms, it could be described as having a dip where the soft spot was. In a little more medical terminoligy, it appears that the coronal sutures (which can be seen) move forward from the center instead of lateral or straight across. Towards the front from there, a dip shows where the anterior fontanelle was. I realize that only a very limited diagnosis can be done from this description without photos or an office visit, but if any of these questions can be answered, it may be in my interest to further pursue treatment. After reading some of your blogs, it sounds like there may be some type of injection that can be used (instead of surgical implant. Is this true? If so, what does it entail….how good and permenant are the results or what are the side effects?; Are there scars left? Is that something that can be done as an outpatient procedure? Can it be done in one visit? What is the complete process of steps to do from start to finish? Do you have an approximate cost? Do you know if any insurances would cover such a procedure? An implant is probably out of the question, but that may be the only option.

A: Your fundamental question is whether an injectable cranioplasty may be an option for your skull deformity. Bt description, you have what I term a large skull ‘dimple’, a circular depressed area somewhat like a crater. They often occur where the original anterior or posterior fontanelles were and represent delayed or incomplete fusion of the bone. (usually just a contour deformity where the four bone edges merged to close the soft spot) You are correct in assuming that an open cranioplasty with the application of an hydroxyapatite bone cement to recontour the area would be the perfect skull contour solution. However, a larger scalp incision in a balding male may have its own aesthetic issues so the pursuit of an injectable approach has merit.

The concept of an injectable cranioplasty should not be confused with that of traditional injectable fillers for aesthetic facial applications. It does require a very small incision which is necessary to lift up the adherent scalp tissues around the bone  defect and to make a pocket for the injectate to be placed. What makes it injectable is that the characteristics of the bone cements are such that they can be placed through this small incision by a syringe or tube and molded into and around the defect by hand from the outside. Thus, an injectabr cranioplasty is probably better termed a ‘limited incision’ cranioplasty as it relates to the surgical access and not just the flow characteristics of the bone cement material.

An injectable cranioplasty is a fairly simple procedure done in a one hour procedure under general anesthesia. There is very limited recovery and no physical restrictions after surgery. General cost ranges would be between $4500 and $5500 for the procedure. This is not a procedure that would be covered by insurance since it is an aesthetic skull contouring and is not provided any functional improvement. While almost all such skull dimples are partial-thickness contou defects, it never hurts to get a preoperative 3D CT scan to clearly visualize the skull defect.

Dr. Barry Eppley

Indianapolis, Indiana