How Can My Traumatic Skull Indentation Be Fixed?

Dr. Eppley, When I was two years old, I fell down a flight of stairs and smashed the front of my head against a wrought iron railing. According to my mom, the hit “cracked my skull open.” As far as I know, I was taken to the ER where they performed some kind of surgery to get my skull back together. The trauma left a scar about three inches long in the front of my skull, but it also left what I consider to be a significant indentation in the front of my skull. I’m 52 and it has bothered me for my entire life, but up until recently has been covered by my hair. Now, I’m starting to lose my hair in the front and the thought of this years old secret being revealed is terrifying to me. I know the pictures are terrible quality, and they don’t indicate the problem very well, but I was hoping to get your take on it as I try to navigate this problem. Even a rough estimate of what something like this might cost would be helpful, and what options I might have as well. In your opinion, might an insurance company pay for part of the surgery? Any advice you could offer would be appreciated!

A:Thank you for sending your pictures. While the nature of your original injury may be uncommon having a skull contour indentation with an overlying surgical scalf scar is not rare. More importantly the improvement of the skull contour as well as a scar revision can be concomitantly done and would certainly provide improvement. How the skull contouring would be improved depends on first looking at a 3-D CT scan to fully understand the extent in depth of the indentation. Most commonly a custom skull implant would be made for that improvement based on the 3-D CT scan.  In more limited skull contour depressions with wide-open exposure during the existing scalp scar it is also possible that hydroxyapatite bone cement could be used for smoothing out the bone indentation. Until I see the 3-D CT scan I could not say which skull contouring option may be preferred.

Dr. Barry Eppley

World-Renowned Plastic Surgeon