Q: Dr. Eppley, I’m honored that a surgeon of your stature and extensive experience in reconstructive/cosmetic surgery has replied to my posting. My understanding was that “Kryptonite” was the best material to be used for a cranial implant. I also have a burr hole just above one of my eyebrows and I believed “Kryptonite” would be suitable for both the supraorbital implants an the burr hole plug. As you know HA is brittle. Both HA and PMMA lack the osteo-conductivity of Kryptonite so what is the problem with Kryptonite will it be back on the market at some point or is it off the market for good? I hate the idea of having too loose foreign bodies floating on my forehead. Could enough bone be taken from my hip to carve two implants for my eyebrows and the burr hole? Theres also a crack that extends downwards from the burr hole. What would you put on this crack.? Bone shavings? If access to the burr hole form the endoscopic brow lift of the upper blepharoplasty isn’t good enough, would it b possible to mke an incision in the eyebrow that will be covered by hair? As you can imagine I would like to avoid a coronal incision at all costs although I had one before and didn’t have any problems afterwards. Would this surgery need to performed by a plastic surgeon like yourself an oculoplastic surgeon, or a maxilofacial surgeon? You are not a maxilofacial surgeon, correct?
I thank you in advance for your help.
A: I believe you have some basic misunderstandings about the various bone cements. Kryptonite is no more osteoconductive or has higher biomechanical properties than its ‘cousins’, the hydroxyapatite cements. Kryptonite is composed of calcium carbonate while hydroxyapatites are composed of calcium phosphates, thus they are very similar. They are not brittle when applied to the bone and do not become loose. I have used them in many patients for cranial defects and for forehead/skull brow augmentation and have never seen any issues with fracture or fragmentation. That is a theoretical concern that has little clinical relevance.
While Kryptonite had the one feature of some degree of injectability, it otherwise has no other biologic or mechanical advantages. It is no longer available, to the best of my knowledge, because the company voluntarily withdrew it from the market for reasons they did not disclose. I would have no idea if it would ever be back on the market. But your case is not a good case for injection anyway due to your prior surgeries and scar.
The best solution to your brow/forehead issues is to re-open your coronal scar, fill the burr hole and cracks with hydroxyapatite cement and build up the brows also with hydroxypatite cement. This would provide the good access to do the procedure properly. This can not be done through an endoscopic approach nor would the scars through the eyebrows turn out very well. I understand your desire to avoid the coronal incision but that can not be avoided and get a good smooth bony result in the desired shape and fill.
Lastly, I am board-certified in both plastic and reconstructive surgery as well as oral and maxillofacial surgeon with a lot of craniofacial experience since you asked.
Dr. Barry Eppley