Skull Augmentation Materials

Q: Dr. Eppley, i’m looking to do skull augmentation and I noticed you often use PMMA material for implant but other doctors refuse it saying it causes inflammation in 40% of cases and only use PEEK. In your experience how safe is PMMA and do you overcome its sterilization issues when prepared? My target is large skull augmentation since my problem is small head/face.

A: Thank you for your inquiry. Let me provide you with some clarifications on some of your skull augmentation biomaterial statements in your inquiry.

1) For elective aesthetic skill augmentation today, I primarily use custom made silicone skull implants from the patient’s 3D CT scan. That is a far superior method to the use of any form of bone cements or PEEK material for a variety of reasons.

2) When I did use PMMA bone cements I never see any problems with inflammation or infection…and I have used it in hundreds of cases.

3) You should not confuse aesthetic onlay skull augmentations with reconstructive cranioplasties which are done to fill in a removed or lost full-thickness skull defect. These are completely different patient populations which have different risk profiles and tissue makeups. It is that population to which other surgeon’s comments are most likely directed. 

4) If large skull augmentation is your aesthetic goal, you will require a first stage scalp expansion followed by a second stage skull augmentation with a computer-designed skull implant. That is the only effective way to achieve that kind of skull enlargement in a safe and predictable way.

Dr. Barry Eppley

Indianapolis, Indiana