Do I Need A CT Scan To Get Sagittal Ridge Skull Reduction Surgery?

Q: Dr. Eppley, I have several questions about sagittal ridge reduction surgery: 

– Is a CT scan required if only burring will be performed (e.g., no implant)? 

– Do all sagittal ridge reductions require placement of a drain? If possible, I would like to avoid a second scar from the drain tube, even if it means a slightly longer recovery. 

– What determines the length of the incision? Is it the amount of distance you need to sweep the burr left-to-right (laterally)? The length of the ridge (posterior-anterior)? The curvature of the skull? The tightness of the scalp? 

– What determines the shape of the incision? For posterior ridge reduction, I noticed that some of your incisions have more of an arc (u-shape), while others are closer to a straight line. Why the difference, and does the patient have a choice of incision shape? 

– Are dissolving sutures used, or does the patient need to return to your clinic to have the sutures removed? 

– Will hair grow through the scar tissue? 

– For those who do opt for an implant, how often does the implant’s edge become visible once the swelling resolves? For horseshoe-shaped implants, I assume that it’s difficult to get the prefabricated implant to transition seamlessly into the burred crown region. 

– Have you done any off-label testing of verteporfin to minimize scar formation? This could be a game changer if it’s effective! 

A: In answer to your sagittal ridge skull reduction questions:

1) A preoperative CT scan is not usually needed if no implant is required.

2) All sagittal ridge skull reductions require a drain which is removed in 24 hours and leaves no visible scar when healed.

3) The length of the scalp incision is based on how much access is needed to properly do the reduction. I always start out very small and then enlarge as needed.

4) The shape of the incision largely follows the hair pattern. I have no preference if it is straight or curved. It heals very well either way.

5) Small dissolvable sutures are used which don’t need to be removed.

6) Hair rarely if ever grows through a scar. The real question is whether the hair will grow right up against the edge of the pencil thin scar…which it usually does.

7) Generally implant edging is either non-existant or very minimal…as has been revealed many times in the patient that provides the most severe test of that effect…the male who shaves his head. It is usually not a problem because I lok for it and adjust the implant edges as needed.

8) I would not use Verterporfin in humans based purely on studies performed in mice. How that translates to humans is not yet known…not so much in regards to its benefits but rather what the adverse side effects with its use may be. Why take an operation which typically has superb scars and risk it for a very minimal benefit. I shall await what incisions in humans reveal with its use.

Dr. Barry Eppley

Indianapolis, Indiana