Can The Back Of My Head Be Reshaped So It Is More Normal Looking?

Q: Dr. Eppley, . I am currently 24 years of age. For several years now, after maintaining a short haircut, I have received comments from several peers that the back of my head is flat and that the posterior is slightly raised. It has come to the point where I felt I needed to do something about it. After research, I came across the term ‘positional plagiocephaly’. Because of the raised posterior, I find it uncomfortable to wear bicycle helmets as it will press on the posterior of my head. Headphones generally do not fit upright unless I tilt them to the front or back. Psychologically, I have suffered to some extent as it is hard for me to maintain a long haircut in my country’s humid climate and I am conscious about the shape of my head and would not like it to bother me as I develop my career. I would like to consult if my condition looks serious enough to warrant surgery for cosmetic reasons. I would also like to ask whether the skull reshaping surgery would reduce the height of my skull to a fair degree, so that the top of it looks more rounded, less angular and protrusive or if I should consult a craniofacial specialist to perform a more invasive procedure. I understand that without an x-ray, it is difficult to determine how much bone can be shaved off.

A:Your concerns about the shape of your head are of the most common variety that I see. A flat back of the upper skull and an increased cranial height in front of it often go together. It most likely was from early positioning issues as an infant but that is irrelevant now. The important question now is can it be improved and by how much. First, forget about any major cranial surgery at this point in your life. (actually anytime after two years of age) The bone is too thick and the magnitude of the surgery too great to take it all off and reshape it. This type of surgery, while working well in infants, is not an adult possibility. This leaves the option of external skull reshaping through either bone reduction (high posterior) and occipital augmentation. (building out the back) Together this can make a major difference if the scalp incision/scar required to do it is acceptable. Ultimately you are correct in assuming that an x-ray would be needed to see how much bone can be removed.

Dr. Barry Eppley

Indianapolis, Indiana