Can Skull Reshaping Be Done For The Nuchal Ridge?

Q: Dr. Eppley, I am interested in an unusual form of skull reshaping. I am currently investigating possible procedures that could change my skull contour. I have congenital skull asymmetry/tilt, and have attached a simple drawing approximating the current shape of my skull. The area I would like to treat is on the left side of my posterior skull/occipital bone. If possible I would like some reduction of the skull near the occipital bone/protuberance and nuchal ridge on that side. In addition to this I would like to increase the volume beneath the ridge with a fat transfer. The goal of this would be to make it appear as if the nuchal ridge was lower on that side than what it actually is. My understanding thus far is that a solid implant would not be suited to this area as it could not be secured and it would have to lie on top of tendons/nerves and I’d prefer a more long lasting treatment over temporary fillers. Assuming there is enough bone that some can be safely removed, what amount (i.e. how many mm) can this part of the skull usually be reduced? I’ve seen photos of fat transfers treating various defects on different parts of the body and am curious how much projection could potentially be possible. The area I would like to increase volume in is roughly 2cm wide and 7cm long with varying depth. The depth would vary up to a max of 1cm. I know that fat transfers are unpredictable and can take multiple sessions, but I’m curious is this would be potentially feasible. My weight is stable and does not fluctuate much. In your estimation would these procedures be technically possible or something that you could potentially perform? I would very much appreciate your input.

A: Skull reshaping can be done for a wide variety of bone issues. The area to which you want to reduce is known as the nuchal ridge of the occipital bone. It is actually where the posterior neck muscles attach to the skull. As a result it is very thick to accommodate the pull of these strong neck muscles, illustrating the biologic principle of form following function. This is why it is a raised edge of bone and can be substantially reduced in its prominence by a burring technique. As for augmenting the area below it, fat injections can be done but I would have little confidence that they would create, even if they survive, a raised ridge presence. You would be better served to have an actual implant placed down that low and secured to the bone. Since some of the neck muscle tissues has to be released anyway to do the burring, it would be more reliable to attached a small silicone implant with those dimensions to create an assured permanent ridge effect.