Q: Dr. Eppley, Is there a limit to what volume of cranial augmentation can be done in a single procedure ? I imagine that the lack of loose skin in that area will restrict the amount of filler material that can be injected, because the skin would have to stretch to accommodate it. Does this mean that the procedure must be staged over several visits ? Or do you employ those subcutaneous balloon dilators to generate excess skin before you start ? Many thanks for your time.
A: You are correct in your assumption that the overlying skin can be a limiting factor in how much cranial augmentation can be achieved. If a significant amount of augmentation is needed, then the use of tissue expanders may be necessary. This is very rare due to the obvious staged nature of the process, but more extreme cases may necessitate it.
Based on my experience, frontal augmentation cranioplasties can take up to 120 grams of material and still get a coronal incision closed. Conversely, an occipital augmentation due to the tighter scalp in the area can only accomodate 30 to 60 grams without compromising incisional closure. While these implant volumes will achieve the results most patients want, there are exceptions where less amounts of augmentation have to be accepted or the use of a first stage tissue expansion must be done.
Dr. Barry Eppley