How Can I Reshape The Top Of My Head?

Q: Dr. Eppley, I am interested in a virtual consultation as soon as possible regarding skull contouring. My primary concern is a crown/sagittal ridge prominence on the top-back portion of my skull, along with a shallow depression immediately in front of the ridge.

Based on photo review, I estimate the ridge prominence may be approximately 3–5 mm above the adjacent contour. My goal is to create a smoother crown contour while preserving my forehead shape, forehead slope, facial proportions, and lower occipital contour.

I would like your opinion on whether approximately 3–5 mm of ridge reduction and, if appropriate, 1–3 mm of augmentation of the adjacent depression using PMMA bone cement would create a smoother contour, and what results may be achievable based on CT imaging.

Thank you for your time, and I look forward to your assessment.

A:Thank you for your inquiry and sending your pictures. I would certainly agree with your skull shape assessment of the presence of a higher crown area with a classic coronal dip/valley in front of it to which I can make the following comments:

1) You have a higher crown area, not a sagittal ridge. The difference is the wider shape and broader need for bone reduction.

2) I would not treat the coronal dip with bone cement which is plagued by contour irregularities unless one is going to make a long scalp incision where it can be placed and shaped under direct visual access. I would assume that in a shaved head male avoidance of long scalp incision would be a priority to avoid.

3) The coronal dip is best treated by a custom skull implant in which its shape and contours are assured and it can be placed using a very small scalp incision.

4) I think the real critical decision here it Is do you just treat the coronal dip alone or with crown skull reduction. I make that distinction because to do an adequate crown reduction the scalp incision is definitely going to have to be longer. Whether the length of that scar would be a reasonable trade-off is going to require further discussion.

Dr. Barry Eppley

Plastic Surgeon