Skull Augmentation

Q: Dr. Eppley, I am interested in skull augmentation. I have a depression on the back of my skull which has bothered me for numerous years. I have had it since birth so it has not been caused by an accident. I would be interested in injecting PMMA to fill the area or inserting an implant, however, I am worried about the side effects, especially since it is not a common procedure. I have long hair, will the incision cause a bald spot on my hair line? Is there anyway to make another incision which does not affect the hair? Is PMMA safe or could my body reject the substance? Would an implant stay in place with only soft tissue holding it in place? Is this procedure possible under local anesthesia? The reason I ask is I have a surgery planned for August under general anesthesia, and I am told general anesthesia sessions must be spaced 6 months apart, however I would like this surgery sooner than that. Thank you for your time.

A: Filling in flat spots on the back of the head (skull augmentation) is one of the most common of all aesthetic skull reshaping surgeries. It can be done successfully by either bone cements or implants based on the size of the defect and patient preference. Most patients opt for either custom or semi-custom silicone implants because of their ease of insertion, smaller placement incisions and lower risk of palpable implant edge transitions. The body does not reject such implants although there is a very low risk of infection. The implanted materials doe not affect overlying hair growth. Any potential hair growth alterations lie along the incision line. These type of skull augmentation procedures are best done under general anesthesia not local anesthesia. I am not aware of any medical validity to the need to space a general anesthetic six months or any number of months apart.

Dr. Barry Eppley

Indianapolis, Indiana