Q: I am very interested in learning more about the Kryptonite Bone Cement for injectable cranioplasty. I am a 36 year old female with a very unusual shaped head in which I have always hid behind various hairstyles for shame of the overall appearance of my head. I strongly believe that the shape of my skull may be the result of some form of untreated craniosynostosis or other undiagnosed craniofacial disorder. Or maybe it might just be plain old bad genes.
My skull is very narrow and somewhat small. The shape of my forehead slopes back at such an undesirable angle and is very flat and narrow in width. The resulting slope of my forehead extends up into the top of my skull of which I can only describe as a point. There is somewhat of a flatness in the center of my skull and the back of my skull is very flat and extremely narrow in width as well. I am also very hollow in the frontal view at my temple area around my eyes with very wide cheekbones and a deficient jaw and chin. I have always wondered if there were any such cosmetic procedure that could help in this kind of skull case.
My questions are: 1) What are the biggest benefits of using the older PMMA and HA methods over the new Kryptonite Cement method? How long has Kryptonite Bone Cement been used? 2) Can it be used for adding volume to reshape an entire skull like mine, making it more rounded and add mass in largely deficient areas? 3) Can it be done with scalp hair in place or does the hair need to be shaved for a better view of the entire head? 4) Is there any chance that the material will become detached from the skull and slide out of position? 5) Will the scalp expand and conform to the newly added volume comfortably? 6) Can it be used in place of such procedures as chin and jaw implants?
A: Thank for your insightful questions in regards to your craniofacial concerns. My answers would be as follows. 1) All three cranioplasty materials will work in an open scalp approach. Only Kryptonite can be injected. There are substantial cost differences between the material cost of HA and Kryptonite being over 10X the price of PMMA. For very large scalp areas, the issue of cost makes PMMA the only practical choice for most patients. 2) All the materials can be used over large skull areas. In larger areas, the cost of PMMA makes it the material of choice. 3) For large skull areas, the hair would have to be shaved to see what one is doing. For an isolated forehead cranioplasty, the hair is not shaved. 4) No, all cranioplasty materials stick quite well to the underlying bone. 5) The scalp can expand to a large degree but the skull must not be expanded (built out) greater than what can be closed over it. 6) No as yet. Kryptonite has not been yet tested for use in this way. For now, standard facial implants are more predictable and far less expensive.
Dr. Barry Eppley
Q: Dr. Eppley, I have a question about the cranioplasty operation. I had some frontal bone augmentation done two weeks ago with acrylic material. I had it done to get rid of some irregular areas that were quite prominent on my forehead. I had a craniosynostosis repair when I was one year old. I know that swelling is to be expected but I thought most of it would be gone by now. It appears asymmetric between the two sides of my forehead and doesn’t look quite even. Am I being too optimistic about the swelling?
A: It is normal that patients are generally quite overoptimistic as to how long it takes to see the final result of the cranioplasty procedure. While two weeks may seem like an eternity when you are the patient, six to eight weeks is the realistic time period to see about 90% of the final result…and 3 months after surgery before one can make a final critical analysis. That’s how long it takes for the scalp tissue swelling to go completely away and all areas to settle. The thicker the tissues are, the more swelling and the longer it takes for it to go away…and the scalp tissues are quite thick.
Another interesting note is the concept of bilateral (two-sided) surgery. Even though the same thing is done to both sides, the swelling that occurs is never, or rarely, the same. So any asymmetry at this point I would still judge to be swelling differences and not yet proven to be some differences in the degree of forehead symmetry from the augmentation.