Is 25mms A Realistic Amount Of Occipital Skull Augmentation?
Q: Dr. Eppley, , I’m interested in a skull reshaping (flat back of head). My estimate is that I would need approximately 25mm to come to a ‘normal’ shape. I understand that this would require a skin expander that needs to be applied for 6 weeks or so. As I would need to travel from Europe is there an alternative? For example, could it be done in two steps by adding 15mm with bone cement and than in a second step add another 10mm or so (couple of month later)?
A: Having performed more of this type of skull reshaping surgery (occipital skull augmentation for a flat back of the head) that just about anyone in the world at this point, I can tell you that adding 25mms (no matter how it could be done) will create another aesthetic problem. Most people do not realize that the lower end of the occipital skull stops at about the level of the top of the ear. So bringing out the back of the head that much will create a very unnatural step-off below the area of augmentation. Having done this I can tell you that it will look and feel ‘strange’.
Thus you need to focus on a small amount of occipital augmentation that does not excess more than about 15 to 18mms of projection at best. This would still ideally require a first stage tissue expansion. Settling for 10 to 12mms of augmentation can easily be done in one stage.
While sequentially adding material in stages for skull augmentation seems to make sense, it does not work. Each surgery makes the scalp stiffer due to scar so the first surgery (short of using a tissue expander) is the best opportunity as the scalp is the most flexible. Either short for the ideal through a two-stage skull augmentation process or settle for a lesser amount of augmentation as a single stage.
Dr. Barry Eppley