Do Custom Skull Implants Require Screws For Fixation?

Q: Dr. Eppley, First off, my desired surgery objective is still this: a more symmetrical, fuller, rounder head shape, with no (or very minimal) impact to hair follicles and craniofacial health.

With this aim, here are some questions I’d like to have your views on. I really appreciate your time to attend this email. Thank you Dr. Eppley!

1. About screws

I learned that in most cases, screws are used in order to stably attach an implant to one’s skull. These photos show how they look: https://exploreplasticsurgery.com/wp-content/uploads/2018/09/Screw-Fixation-of-Custom-Occipital-Plagiocephaly-Skull-Implant-intraop-Dr-Barry-Eppley-Indianapolis.jpg

What is the material of the screws, 100% titanium?

Are they screwed into the skull bone?

If so how deep do they go?

Are there chances that the way the screws are drilled does harm to one’s brain in particular, or to one’s health in general?

Are screws detectable when the person is going through a security check/scan, for example, at airport customs or other similar sort of checks in public places?

Is there other attachment methods that don’t use screws?

If using screw is the best option, why?

2. Implant material

In one of your articles, it says “Total skull enlargement and augmentation can be done using either bone cements or a custom implant”

Which method should I choose and why?

Will an implant with either method cause migraine and headache to a patient?

Does the procedure cause hair follicle damage (consequently causing hair loss) post-operation, in short-term or permanently?

Is there things that I can’t do due to having an implant on my skull, for example, some intense sports, pressure massage on the scalp, or other strength and movement placed on the head?

Will either material cause problems or discomfort feelings when I am in hot temperature, for example in a sauna, or tropical summer climate with 40+ degrees, and in icy cold environment, say winter in North Canada?

What is the worst case of side effect caused by implant material?

One of your articles talks about injectable bone cement. https://exploreplasticsurgery.com/product-review-osteovation-injectable-bone-cement-small-skull-contouring/

For my case, is there benefit of using injectable bone cement, compared to custom implant(s)? Why?

3. Pieces of implant

In one of your articles, it says “A large custom skull implant replacement requires a two piece design approach to keep the scalp incision more limited.”  

For my case, would you recommend to have 1 or 2 pieces (known as geometric split implant insertion technique?)? Why or why not?

Where is recommended for the incision?

4. Design and desired shape

I could see this case study has some similarities to what my shape issue is and what the outcome could be. I may prefer a rounder shape outcome instead of square shape in this example though.

https://exploreplasticsurgery.com/case-study-creating-the-model-head-shape-with-a-custom-skull-implant/

May I know what are the parts that I will be invovled during the design stage?

I know there requires doing 3D CT scan, discussing on a design, and maybe other parts?

I currently live outside the U.S., but I can consider to come to the U.S. during the design stage, if this is necessary to help create a better design. Do you think this is necessary? Where is it better to do the required 3D CT Scan, in Australia or the U.S.?

5. About first stage scalp expansion

My understanding is that it is very similar (or just the same) to a regular augmentation procedure. The only difference is that by doing it, it is assumed that there will be a second time procedure with the aim to further enlarge the implant size/volume. Therefore, a “first stage scalp expansion” itself is a separate, complete skull reshaping procedure, and after that, whether or not one pursues a second surgery is optional.

Is my understanding correct?

As the ideal scenario is that my shape problem could be solved fully (or to a high level of satisfaction) through one single surgery, so I’d like to find out more specifications of the design during the design stage. I can’t wait to get to that stage : )

6. About potential removal

Are there common reasons that one needs to remove an implant during later stage in their lives?

If needed, can a removal be done, and is there major risk from a removal?

7. Other questions

How long do you suggest me to stay in the U.S., for best catering to the designing stage and recovering from surgery?

What is the earliest procedure date can be booked, if you have information on this?

Is there recommendations on budget accommodations?

Thank you for your attention. I really hope all goes well on your side. Speak soon!

A: In answer to your skull augmentation questions:

1) Screws are made of titanium and are self-drilled into the skull to a depth of about 2mms. They are not detectable by an airport scanner.

2) Custom skull implants made of solid silicone are the superior augmentation method because they are premade based on the patients’s 3D CT scan and can be placed through much smaller scalp incisions than the full coronal scalp incisions that bone cements require. Because they are placed down the bone level they have no adverse effects one the hair follicles or hair growth.

3) A first stage scalp expansion is needed of the patient requires more than a 125 to 150cc volume of implant augmentation.

4) The shape of the custom skull implant can be whatever the patient wants since it is predesigned from a 3D CT scan which the patient gets in their geographic location. All imlpant design planning can be done remotely.

5) Whether a first stage scalp expansion is needed is based on the patient’s aesthetic desires. (how much augmentation do they want and what are they willing to go through to get it)

6) A custom silicone skull implant is easily rempved/reversed if desired.

7) Most patients return home 2  to 3 days after surgery.

Dr. Barry Eppley

Indianapolis, Indiana