How Long Is The Incision For A Sagittal Ridge Skull Reduction?

Q: Dr. Eppley, I have a prominent sagittal ridge on my skull that has bothered me greatly since I began losing my hair several years ago. I’ve viewed your before-and-after sagittal ridge reduction photos, and have a couple questions for you:

As you can see from my attached profile photo, the midline ridge on my skull is prominent not just on top but also extends about half way down the backside of my skull. Is it possible to obliterate the full length of the ridge through just one incision? If so, approximately how long would such an incision need to be?

On a related note, in one of your “after” photos, I noticed that the gentleman has a raised area below the horizontal incision (on the back of his head). Is this raised area simply post operative swelling or is it excess bone that you couldn’t reach with your rotary burr?
Are there any curved burrs or blades that would allow you to more easily work around the curvature of the skull?

Thank you for taking the time to answer my questions.

A: The extent that any sagittal ridge can be reduced is a function of the thickness of the bone (before the inner cortex is encountered) and the length of the incision ‘permitted’ to do the procedure. It is not a function of the rotary burrs or large rasps that are used to do the surgery. They all can more than adequately take down bone at any location. To work around the curvature of the skull, incision location is the key element in sagittal ridge skull reduction. The more it it is located to the back of the head, the further around the skull curvature one can go. Generally incisional lengths will range from 5 to 7 cms.

Dr. Barry Eppley

Indianapolis, Indiana