For My Asymmetric Skull Can I Augment The Flat Side and Reduce The Bigger Side?

Q: Dr. Eppley, my skull has been misshaped since birth; the exact reason has never been medically diagnosed. Once delivered, I had a bruise on cheek, swelling, and head shape that was not symmetrical that the doctors said would fix itself as I aged. My inquiry is in regard to a custom implant for the “flat side” and skull reduction for the side that bulges. I had a surgeon look at the possibility of a custom implant, but he was uncomfortable with skull shaving since that was not his expertise.

A: Thank you for your inquiry and sending your picture and 3D CT scan. Yours is certainly not the typical plagiocephaly which is a common cause of flatness on one side of the head and a protrusion on the other side.  Regardless of the cause the approach of custom implant augmentation on the flat side and bony reduction on the protrusive side would be a logical approach to which I would makle the following two comments:

1) When designing a custom skull implant that crosses over the bony temporal line onto the side of the head  you have to factor in the thickness of the temporal muscloe which sits on the bone in that area. If not one can inadvertently make the flatter side more full than the protrusive side.

2) When considering bony reduction of a protrusive skull area considerations are how thick is the bone, how much bone thickness can be safely removed and what is the incisional tradeoff for what ajmount of bone removal. This is why it is important to do a color mapping bone thickness of the protruding area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon