Can My Thickened Sagittal Skull Ridge Be Reduced?

Q: Dr. Eppley, I am a 38 year old male who a few years back as an adult, I underwent reconstructive surgery for a scaphocephalic head shape and frontal bossing which was believes to be do to minor sagittal craniosynostosis. The surgeon burred down the protruding portion of bone in my forehead and did fat grafting to the parasagittal areas to address the somewhat narrowed appearance and give my head a more round and convex shape.

Overall, everything came out very well, my head has a much more proportionate shape, no more frontal bossing and and I am happy with the results. (This was done through a bicoronal incision. The top of the scar healed fine but the sides unfortunately had no hair growth despite it being a trichophytic closure. I had hair transplants put into the scar which you will notice little scabs in one picture as the grafts were taken that same day).

Long story short, despite the shape being much better, there does still seem to be a thickened sagittal ridge on top anterior portion of my head that’s more noticeable when my hair is shorter. You can see in the pictures that the top of my skull is more peaked in the front than in the back where the vertex is.

I was interested in possibly having that corrected within the next year or so and was wondering what your recommendation would be? What is your assessment of the pictures and what do you think I should have done (if anything)?

Since I already had a bicoronal scar which healed pretty wide (except for the top) from the last surgery and I had hair transplants to fix it, I wouldn’t be interested in something that would involve another bicoronal incision, only something that would involve a smaller incision on the top part of my head that could be hidden in my hair since I keep the top a little longer than the sides.

Several pictures are attached of different views of my head wit different lengths of hair.

A: Secondary burring reduction of the anterior sagittal crest can be done using the part of the coronal scalp incision that lies between the two bony temporal lines. (why that was not done in the primary procedure is not clear since it was always there…but that is irrelevant now)  But before that is done a 2D CT scan is needed to look at the coronal slices to see the thickness of the desired sagittal ridge reduction. While it is always thicker due to the micro synostosis you have it pays to be prudent and due an evaluation before doing the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon