Q: Dr. Eppley, I was wondering if skull reduction surgery makes a noticeable difference on the outside. I know the bone can be reduced on the inside but does that mean it also shows as much reduction on the outside?
A: Thank you for sending your pictures. Of all skull reduction areas the back of the head (occiput) is one of the most successful areas to reduce. Its thick bone allows for up to 7mms if bone reduction to be achieved from side to side. Based on your picture that is probably about what you need to bring the central areas of greatest projection back into a more average back of the head shape/profile. I always check before surgery a plain sideview skull film to determine how much of the outer cortical bone can be removed based on the bone’s thickness and the location of the diploic space. As a general rule the outer cortical layer of bone removal averages around 7mms until the diploid space is encountered. In more aggressive skull reduction the diploid space can be reduced down to the inner cortical layer but this is usually not done due to the bleeding that it causes as well as irregular surface it ca create.
Dr. Barry Eppley