Q:I would like my cranium to be more symmetrical. I didnt notice how misshapen it was until I started going bald. The shape is extremely incongruous with my handsome face. I would love to have a consult via skype. thank you for your time.
A: The true shape of one’s skull (cranium) often remains hidden under the cover of hair. For women this rarely becomes a subsequent issue as their hair pattern and density is more stable. This accounts for why I have had very few adult women requesting any skull reshaping procedures. For men, however, close-cropped hair or an eventual bald pate makes the shape of the skull very obvious. This is particularly true when it comes to the back of the head or the occipital region.
While loss of hair makes the skull shape more obvious, it also limits what can be done from a surgical reshaping standpoint. The use of scalp incisions and the subsequent scar must be considered as an aesthetic trade-off for a abetter shaped skull. For many men, this trade-off may not be a good one.
Skype is a wonderful to communicate for potential plastic surgery patients. It allows patients to ask questions and get answers from an expert from the convenience of their own home. I always ask patients to send me some pictures of their concerns beforehand so I can have a good idea during our online discussion. If one has a webcam that is even better as a video consult is the most interactive and informative.
Q: I am interested in getting a portion of my skull reshaped. The top part is narrow and slopes off to the sides. As a man with shorter hair, it would look better if the top was rounder and didn’t slope so much. Can some material be added to build up these areas? There are also two smaller areas on the sides which need reduced. I have attached some photographs which show the areas that I am concerned about.
A: Thank for sending your detailed photographs. That is extremely helpful and you have clearly defined what your skull contouring needs are. There is no question that all of those contours issues can be done. Whether it is some side reduction by burring in the two spots you have indicated or adding a material (PMMA acrylic vs HA hydroxyapatite) to give it a more rounded shape and decrease the slope, that is very straightforward from my standpoint. This is fairly simple craniofacial plastic surgery as it is outer table cranial contouring.
The most relevant question is one of surgical access. While all of those can be done, it is most ideal to do that through an open scalp incision. While you have a wonderful head of hair, this would leave a fine line scar. Given that you wear your hair very closely cropped, I would be concerned that the trade-off of this scar versus the skull contour concerns may not be a good one. I would need your further input on that issue.
Otherwise, there are some more limited injection methods to place materials under the scalp onto the skull bone. This is best done with PMMA which hardens after being injected and can be molded while it hardens. Such limited approaches do not provide enough access for the side bone reductions though. The other injection option would be to place fat grafts instead of a synthetic material. This can be done with a few simple punctures using your own abdomen as the harvest site. The disadvantage of fat grafts is their unpredictability of survival however and how smooth and even the contours would be.
Dr. Barry Eppley