Skull Implant Revision

Q: Dr. Eppley, I have thought long and hard about a skull implant revision and I’d like to go through with a revision on the left side. I tried my best to take pics that would show you exactly what I’m trying to describe… hopefully these will work. 

You can see a gradual rise from the center of my head on over to the left side of my head. I believe shaving or essentially reducing the thickness of the implant will do the trick. The other trick is how much should the implant be reduced? and how will it be reduced? Is there a way to determine how much should be reduced to achieve my desired shape? MRI/CT?

Also, we discussed several options and using the same incision… but I’d like clarification on the risk of infection. I know it is always a consideration, but I’d like to know if simply having a revision will increase the chance of getting an infection? 

The other topic we discussed was the approach. Has this type of revision been done before? And if so what approach was used then? I read on your site that patients at times ask for revisions… is there a percentage on how many achieve their desired state after a revision?

 I am very satisfied with the right side of my head. There is a small area that I can feel and wonder if it can be shaved down or reduced? There was a concern of thickness and I would not risk it if that was a concern. Just wondering. 


A: To answer your questions about a skull implant revision:

1) The original incision would have to be completely re-opened. It may or may not heal as well as the first time.

2) The entire implant will need to be removed to be hand carved for the revision.

3) There is no scientific method to determine how much it should be reduced. That is an artistic judgment.

4) Every time you place or revise any implant in the body the risk of infection exists. Just because it did not happen the first time does not mean it can not happen the next time. Each surgery involves a new set of risks that are independent of what happened before.

5) Whether patients are satisfied with any revision depends on the aesthetic concern being treated and what is being done.

That being said I will pass along to you two basic concepts about revisional implant surgery that I have learned in treating many patients:

1) If you are largely satisfied with an aesthetic outcome, the risks of manipulating implants for making small adjustments could turn out to be a poor benefit t risk decision.

2) There are no perfect implant results. Just like the natural human body there are going to be imperfections. Living with them offers the safest medical course of action.

Dr. Barry Eppley

Indianapolis, Indiana