How Well Do Fat Injections Work In The Scalp For A Fat Wasting Condition?

Q: Dr. Eppley, I am a 36 year old male with a rare congenital fat wasting condition that has greatly affected and deformed my scalp. Over the last few years my scalp has gone from being a normal symmetrical round and smooth scalp to being very asymmetrical switch dents all over the place and prominent bone structures becoming visible. I have included pictures that show what my head looked like before and what it looks like now. Is there anything that could be done to make my head look a normal symmetrical round shape again. I know you work with skull reshaping but it’s not my skull that is the problem it’s the soft tissue. Can anything be done to make it look normal or at least better?

A: Thank you for your inquiry. While you have a soft tissue scalp, there are two potential treatment approaches. First widespread scalp soft tissue augmentation can only be done with fat injections. This would be a logical treatment but, as with any injection fat grafting surgery, these aspects about it must be understood:

1) Injection fat grafting volume retention is highly unpredictable. How much survives and whether it would survive in an even fashion is always a gamble. This would be especially true in the scalp where very little fat grafting experience exists.

2) Why the fatty tissue has deteriorated in your scalp is not known. But more pertinently does this condition make fat grafting less likely to survive ??

3) One has to have enough donor fat to harvest to do the procedure. For the entire scalp you would probably need 250cc of concentrated fat to inject to make the procedure worthwhile. This means that at least 1,000cc of fat aspirate must be able to be obtained to create that concentration. Clearly you have a lean body makeup so getting 1,000cc harvest may be challenging. 

The second approach is to go below the scalp and place an overall thin layer of implant over the entire skull surfaces. This would push out the scalp in a predictable and assured volume retention manner. Even a 3mm layer of bone augmentation around most of the entire head probably replicates what has been lost in terms of scalp thickness.

Dr. Barry Eppley

Indianapolis, Indiana