Skull Reduction Scars

Q: Dr. Eppley, I am contemplating seeing you for sagittal ridge reduction surgery.  My understanding is that the resultant scar will be 5 to 7cm in length, from left to right, at the crown of my skull. I am Caucasian with “medium” toned skin.  While the prominence of the sagittal ridge bothers me tremendously, I’d like to get an idea of how well the scar will heal in order to determine whether surgery will be worth it.  I’ve done an Internet image search for “scalp scars” and the search returns pictures from hair transplantation surgeries, brain surgeries, etc…  A lot of these scars are quite prominent, and it’s difficult for me to figure out what a “fine line” scar actually means in my case. So my questions for you are:

1) How well do sagittal ridge surgical scars heal compared to other cosmetic surgical scalp scars?  Since the surrounding skin is tight at the crown region of the skull, I’d expect there to be tension on the scar, which would make it wider.  Is that true?

2) What can be done, if anything, to improve the scar once healing has occurred.  Is Fraxel effective?  What about other dermatological techniques?  Are there concealer creams that can be used on a daily basis to hide the scar?

3) Do you have more before/after pictures of scars that you can post?

Skull Reduction scalp scar result Dr Barry Eppley IndianapolisA: Your questions and concerns about the scalp scar from skull reshaping surgery is understandable and appropriate given the elective aesthetic nature of the surgery. Searching the internet will not be helpful since just about every surgical scalp scar you see is not what scars from this type of surgery will turn out. There is no comparable other skull/scalp surgery to which this applies. In answer to your questions:

These type of scalp incision usually heal remarkably well and ion many patients can be very hard to detect. These are not scars in which there is any tension since this is a reductive operation not an augmentative one.
There will be no scar treatments that are needed. I have yet to do a scalp scar revision from one of these surgeries as they heal so well. I do many skull recalling surgeries on bald/shaved men and the scar is usually very slight at worst.
Attached see an example of a scalp scar in a shaved head male who had sagittal ridge skull reduction.

Dr. Barry Eppley
Indianapolis, Indiana