Can Skull Reshaping Be Done Under Local Anesthesia?

Q: Dr. Eppley, I am interested in skull reshaping surgery. When I was a baby I had torticollis and i’m pretty sure this is what caused my plagiocephaly. My head looks like it was pushed in on the right side. I think the torticollis made me sleep on my right side a lot when I was a baby and thats why the right side of my head is more flat than the left. Here are some pictures of when I shaved my head. As you can see I would need an implant on the right side just above the ear and on the left side on top of my head to make my skull symmetrical. The back of my head is ok. Could you tell me if this is possible? Also maybe this could be done under local anesthesia with sedation? One last thing, I still have a head of hair and I’m a bit worried that an implant would put pressure on the hair follicles and blood flow resulting in hair loss. Is this a possible risk?

A: Certainly skull reshaping can be done for augmenting these two areas. The only question is which implant material to use. It could be done using either intraoperatively applied bone cement or custom computer-designed implants for each area. Given the asymmetric nature of the skull problem and the various shapes of implants needed, I would prefer to use custom designed implants as the most assured method of obtaining the best skull shape result.

Placing a skull implant is not something that can be comfortably done under local anesthesia/sedation and would not save you any money even if it could. Because a major cost of surgery relates to the time spent in the operating room, local/sedation cases take longer to do than when under general anesthesia. So any cost savings obtained by leaving out the anesthesiologist’s fee is wiped out by the longer time spent in the operating room

Lastly, raising scalp flaps and placing implants has no adverse effect on hair survival or growth.

Dr. Barry Eppley

Indianapolis, Indiana