Scalp Reconstruction

Q: Dr. Eppley, I had a car accident over a year ago and had a portion of my scalp avulsed. I was missing a long swath of my scalp. I had to have surgery where my scalp was undermined and made into a flap and stapled back together. Everything has healed nicely and I have thick hair which covers the scar. However, there is a noticeable dent and asymmetry with my scalp which looks funny and requires me to grow my hair longer on that side to cover the area, kind of like a small comb over which I am not comfortable with. I am interested in having that area filled to improve the symmetry of my scalp and provide a normal look to the shape of my head. I buzzed my head and provided a picture that you will see attached.

A: Since your original injury was a soft tissue one (scalp) and not loss of bone, the indentation along the line of the original scalp avulsion closure is from a soft tissued defect not a bone defect. Building up the skull is not the solution to solving the scalp dent problem. This is a scalp reconstruction issue. The likely solution is either fat injections to release the scalp scar and build up the dent or open the scar and implant a dermal-fat graft or an alogeneic dermal graft. Either way the scalp tissue needs to be built up or thickened to create a smoother scalp contour.

Dr. Barry Eppley

Indianapolis, Indiana