Skull Implants

Q: Dr. Eppley, I have some questions and concerns about skull implants and would really appreciate it if they can be answered in detail.  I am very serious about this operation and would like to find out more about it. 

1) Let’s say I will get this operation during this month, how long will it be approximately before the incision will become unnoticeable? Also, Will I need to be wearing a hat for a certain amount of time until everything clears out to conceal it or no?

2) In what place will the incision be made and is 9 cm going to be the maximum for the incision?

3) Just out of curiously, will the implant be detectable when doing an x-ray or any type of scan at any doctor’s office or will it read as a single part of the skull?

4) Would you say this is a fairly easy operation?

5) Are there going to be any chances of infection/ nerve damage or any complications in the future or during the procedure?

6) Also, once the implant is inserted is it somehow attached or no? Or is it just inserted and the opening is closed?

Do you have any photos of how the incision/scar looks like right after it is closed?

7) Is it true that the thinner the custom implant is or the less material there is, the smaller the incision that needs to be made? Also, is it the patient’s choice or no?

8) Based on your experience, how likely is it that people around you will notice drastic changes of the shape of the head after the operation? Is it significantly noticeable or not noticeable at all?

9) It says on your website that the implants can be sectioned into 2 pieces and reassembled once inserted. Will this have an impact on the length of the incision or no?

10) After the surgery has already been done when can I see the incision disappear?

11) In the previous email you mentioned that it is better to do hair transplant using FUE in my crown area around 6 months after the surgery. Is there a particular reason why there is a need to wait for so long? If I decide to do the FUE before the surgery if it fine, how long must I wait before I can do this operation? Is there a specific time? Can I do it the next day?

12) Does the amount of silicone used affect the price in any way?

13) Is there going to be a significant difference in how it feels after the silicone is placed or no?

14) I am a casual smoker and I smoke very little. I would say I smoke around 1 pack per every two months or so. Also, I don’t smoke every day. Will this have any effect on the post op results such as healing time, etc?

Thank you and regards

A:  In answer to your questions about skull implants:

  1. Provided one has hair for coverage the scalp incision would be fairly undetectable in short period of time. If one has a shaved head the incision will take several months before it fades considerably. The wearing of a hat or head wear is a personal choice, not one that I advocate either for or against.
  2. The incision placement would be based on what type of skull implant is used and its size. Without knowing these specifics I can not give a more specific answer. In general, however, most skull implant incisions are placed posterior more towards the crown of the skull area.
  3. Silicone skull implants are not detectable in plain x-rays. Their outline will be seen in CT or MRIs however.
  4. Placing skull implants can be a straightforward operation for those plastic surgeins who are very experienced in placing them.
  5. While infection is always a risk with any type of implant place in the body, it is not a problem I have yet seen in skull implants. Any other potential long-term concerns are related to the overall size of the implant but, in general, there is no risk of permanent nerve damage.
  6. I generally do place very small screws to secure the implant and use perfusion holes throughout the implant so tissue can grow through it between the overlying scalp and the underlyng bone. Thus making dosens of tissue connections through the implant.
  7. There is no question that the size and thickness of the skull implant affect how long the incision need to be to place it.
  8. I don’t think skull/head shapes are physical features that draw as much scrutiny as other facial features.
  9. While in some cases I do section very larges skull implants or are forced to based in their size or shape, it is not a preferred method as the integrity of the fit to the bone is most assured by placing them in the manner that they were fabricated.
  10. Incisions/scars do not disappear or go away completely. Their redness and visibility certainly improve with time and is a process of 3 to 6 months for maximal scar appearance improvement.
  11. When you induce changes to the scalp you do not want to put too close together traumatic (surgical) events. This stresses the blood flow to the scalp. This may cause hair shedding or, at worse, a devascularizing event where scalp loss may even occur. (I have not seen it but even the robust blood supply to the scalp is not immune to adverse vascular events) Therefore in elective scalp/skull surgery caution is prudent about the spacing of repeated surgeries.
  12. The cost of skull implants is not influenced by volume but by their method of manufacture.
  13. A silicone material placed on bone will feel like bone.
  14. You would be well advised to avoid any smoking for at least 3 weeks before and 3 weeks after surgery. Nicotine is a potent vasconstricting agent and carbon monoxide competes for space on the hemoglobin molecule with oxygen. Good blood vessel perfusion and oxygen levels provide for the best tissue healing possible and lowers the risk of infection.

Dr. Barry Eppley

Indianapolis, Indiana