Does Skull Reduction Make The Skull Weaker?

Q: Dr. Eppley, I googled “skull reduction” and found out that you are the only one in the world who does skull reduction. I see you need a bicoronal incision for this, which is not a problem. I have a big head and can’t wear hats and I am always teased. I read that reduction is achieved throught a rotatory instrument that shaves done the external layer. You said to think about an oreo cookie. When do you reduce the skull, do you only use this instrument or you do osteotomies as well? If you burr the bone doesn’t the skull become weaker and more susceptible to fractures or soft to the touch? Do you perform a lot of these procedures?

A:  In answer to your questions:

1) Cosmetic skull reduction is done by burring down the bone,, not by osteotomies. Osteotomies are major cranial bone flaps are not indicated for cosmetic improvement.

2) The skull does not get appreciably weaker with outer cranial table reduction as there remains an inner diploic layer as well as an inner cortical bone layer as well to the skull.

3) Various forms of skull reduction/reshaping are done in my practice. Whether anyone is a reasonable candidate depends on many factors and I would have to seem some pictures of one’s head to determine if they are a reasonable candidate.

Dr. Barry Eppley

Indianapolis, Indiana