Does Brow/Forehead/Temporal Skull Augmentation Require One Or Two Stages?

Q: Dr. Eppley, I would like to know what the cost of doing an extensive skull shaping surgery would be. I basically want some projection of my glabella tapering down the eyebrows and also I would like to add thickness to the forehead both below and above the hairline if possible. 

I would also want to increase the sides of my head from the temporal region back. I have seen your custom implant designs and my overall goal is to basically get a thicker skull all around maybe 1 cm of thickness on the sides less on the forehead I would think due to managing the hairline proportions. 

I am fine with scars, I believe I have the hair to cover it up well enough. What is a price range for what I would want? Do you preform this kind of thing more often now, once per week? I believe this will be more requested in the coming years (brow and head).

A: Thank you for your inquiry and detailing your skull reshaping goals. In custom skull implants, virtually any surface area coverage and thickness can be designed. That is never the question. Rather the key issue is whether the volume of the skull implant designed can ‘fit’. The concept of fit in skull augmentation means the ability of the scalp to safely tolerate the underlying implant without a significant increased risk of incisional dehiscence and scalp stress. (potentially seen as increased risk of infection and hair shedding/loss) As a general rule the volume of custom skull implants needs to be under 200ccs. Such volumes are always calculated in the design process and such information helps guide the implant design.

Just by your description (1 cm increase on the sides and coming across the forehead) I can tell you without even an implant design that is going to make a skull implant over 200ccs in volume.That would need an implant design that virtually covers 2/3s of the skull’s surface area. (to have an adequate feathering of the implant to blend into the rest of the skull’s convex surface area and to not look unnatural) As an aside to this observation, most patients way overestimate their skull augmentation needs by thickness and under estimate the expansive effects of large skull surface area coverage.

But for the sake of discussion for now let’s assume that your implant thicknesses/size is correct. That leaves you with two options; 1) do a two stage skull augmentation which requires a first stage scalp expansion or 2) reduce the dimensions of the implant so that it falls under 200ccs volume.

Dr. Barry Eppley

Indianapolis, Indiana