Q: Dr. Eppley, I have questions about a custom skull implant My son wants to be a few cm taller. He said doing skull augmentation will let his total height longer by measurement by a few cm. He is about 5 ft 5 inches tall. Is it safe to do skull augmentation? Is the material used safe? Can the material or implant be removed if complications arise later? Will it affect hair growth after the implant or filler inserted? Please explain the steps and procedures a bit. Also the risks, if any. Please suggest and reply as I don’t know what to do. Thank you.
A: I do not see that a custom skull implant is an approach to be used for ‘heightening’. It is ideally used to correct a flat top of the head. It is a perfectly safe procedure which is done using a custom silicone skull implant made to fit the patient from their own 3D CT scan. As single stage procedure the most height that could be obtained would be 12 to 15mm due too the limits of how much the scalp can stretch. As a two stage procedure with first stage scalp expansion, the amount of skull augmentation could be close to 25mms. Placing an implant on the bone will not affect hair growth. The implant is relatively easily inserted and removed secondarily if necessary. In my vast experience with this type of aesthetic skull surgery, I have not experienced any major problems. But the key is to stay within the limits of what the overlying scalp can accommodate.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom skull implant. The back top of my head is flat and I plan to do something about it. my questions are the following:
1. what materials are available and what would you recommend?
2. will the implant affect hair growth, (in some way?)
3. what is the cost and time to recover?
4. side effect, pros-cons ?
I greatly if you can answer these questions for me and looking forward to hearing from you!
A: In answer to your custom skull implant questions:
1) By far the best method of skull augmentation is a custom made silicone implant fabricated from the patient’s 3D CT scan.
2) Skull augmentation with a subperiosteally placed custom skull implant does not affect scalp hair growth.
3) My assistant will pass along the cost of surgery to you on Monday. Recovery is fairly quick with minimal downtown other than some scalp swelling and some mild discomfort.
4) The benefits to a custom skull implant is that it is best method to get the smoothest and greatest amount of skull augmentation with the smallest incision. Its downsides are that it does require an incision to place it (7 to 9 cms long) and may or may not be able to achieve the desired amount of skull augmentation as a single stage procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in occipital and forehead augmentation. I am aware of custom forehead and occipital implants but I have several questions for which iIhope to get answers.
1. I do know through research that there are alternative material called PMMA, how does this compare with pre fabricated silicone ?
2. Which one is cost effective?
3. Which one get less side effect and after-problems?
4. If I included my forehead, are we using the same materials?
A: In answer to your additional questions:
1) You are referring to PMMA, a born cement material which is applied like a putty, shaped and than allowed to harden. This is what I used a lot before custom skull implants of which has largely replaced PMMA bone cement in my practice.. A custom skull implant is always better because its shape and exact dimensions are made before surgery. Because it has a preformed shape it is also put in with a smaller incision and less operative time and with a much lower risk of revision due to irregularities or edge transitions.
2) A custom skull implant costs more but PMMA will exceed that cost of a revision surgery is needed due to irregularities or edge transitions.
3) A custom skull implant has much lower revisional surgery risks than PMMA bone cements. It is also much easier ti remove and revise if that need should arise.
4) The issues are the same in the forehead where a custom implant works better than PMMA bone cement.
But the differences between using a custom implant vs. PMMA bone cement may be greater or more similar depending upon the size of the front and back of the head augmentations desired and how much scar length one is willing to tolerate. I would really need to see pictures and do computer imaging of you to get a better idea as to these very important issues.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom skull implant. I’m a 52 year-old Asian male and am very interested in your skull augmentation procedure. In my case it would be the higher region of the occipital lobe, about 45 degrees between horizontal and vertical (I’m extremely flat and no volume). Could you please send me as much information as you can regarding the nature of the procedure, costs, risks, scars, recovery, and the maximum possible increase in convexity that can be achieved to that occipital region. Thanks so much.
A: Thank you for your inquiry. Crown of the head augmentation is best done by a custom skull implant made from a 3D CT scan. The critical question is whether the existing scalp laxity will allow for maximum convexity to be achieved as a one-stage procedure or whether it may require a first stage scalp expansion. That would depend on how how much thickness the implant must have to achieve what one sees as maximum convexity. As a general rule, up to 12mms or so can be comfortably done as a one-stage skull implant. Increases of 15mms or greater almost always require a scalp tissue expander first.
I would need to see pictures of your head in profile and do computer imaging to help determine the important consideration of implant thickness required. While custom skull implants can be made to any dimension and thickness, the limitations in their design are in how much the scalp can be stretched to accommodate the underlying added volume.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom skull implant for my occipital augmentation revision. I came across this company in my research, Xilloc, which uses 3D printing technology along with CT scan image to manufacture patient specific implants using various materials.
They are on the verge of licensing and releasing a new technology for bone implants called CT-Bone. The patient’s implant is made by printing the material from calcium phosphate. Since calcium phosp is the primary constituent of natural bone, the implant fuses with the existing bone and the body integrates with it just as natural bone bone. The material can also be controlled to exhibit the same porosity as natural bone which may aid in vascularization. The future of cosmetic surgery looks so exciting with this technology. Scientists have also printed human organs like skin, liver and heart with 3d printers using human tissues. Hopefully it will be available in the US market as well.
I really like to have my surgery redone but i have many concerns and expectations that hopefully can be solved with newer and better options.
-100% biocompatible material
-no use of metal, including titanium screws
-desired cosmetic correction, smoothness and symmetry
Will you please look into this, Dr. Eppley.
With your expertise and skill and open-mindness I think anything is possible.
A: I am familiar with many custom skull implant technologies but there are multiple limiting factors. First many such porous hydroxyapatite or calcium phosphate materials tend to be form and less malleable. This creates challenges in surgical placement particularly for the aesthetic skull augmentation patient. A stiffer skull implant material requires a long incision to insert from ear to ear and a complete turn down of the scalp flap. Second, calcium phosphate materials can be more difficult to be made down to a smooth feathered edges. Thus there will be very palpable step offs at the edges of the implant when used as an onlay. This is not an issue for an inlay skull implant but is a huge aesthetic concern in an only skull implant down for aesthetic purposes. Third, the average cost of just the implant alone can be considerable. I don’t the know the exact cost of what this skull implant would be from this company but I would expect it to be more than new thousand dollars.
What you have to appreciate about this technology is that it is understandbly made for inlay bone defects and not primarily for onlay bone augmentations. It is geared for patients who had have skull defects from trauma and neurosurgery and are likely covered by insurance who can absorb the high cost of the implant.. For all of these reasons this may not be a custom skull implant technology for the aesthetic skull augmentation patient. This is a great example of while the technology is great the material chosen for it may limits its application in outer skull contouring/augmentation.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom occipital implant. My head is obviously flat. I have been insecure about it since my teenage years. I am know in my late 20’s. I am interested in a custom occipital implant to make the back of my flat flat head perkier and rounder. I was wondering what the estimation of this procedure would be? I was also wondering, since you cut the hair/skin part of the back head, is the scar obvious (aside from hair covering it)? For example, if I were to show that area would the scar be obvious? Thank you. I look forward to your reply.
A: For augmentation of a flat back of the head, a custom occipital implant is the best method. It does require a scalp incision somewhere and that would depend on its size and location on the occiput. The scalp scar usually turns out very well particularly in women. If you shave your head the scar would be somewhat obvious but that is the situation you probably are not going to find yourself in. Great care is taken in aesthetic skull reshaping surgery to preserve hair follicles along and around the scalp incision.
Dr. Barry Eppley
Q: Dr. Eppley, I am hoping you can give me your professional opinion about my problem. I have been bothered by a fairly flat back of my head for decades now and I am at that point that I really want something done about it. Some stories sounds promising which make me hopeful but I am not even sure I am a ‘suitable’ client. What do you think as far as you can tell from a picture? How long will the procedure take (from intake to recovery) as I need to travel to the States. Thanks for your time.
A: When it comes to determining a good candidate for back of the head augmentation (occipital augmentation), pictures can go a long way in answering that question. Please send some to me at your convenience. The issue is not likely going to be whether you can have the procedure done but whether it is a one-stage vs a two-stage procedure based on your back of head shape goals and your natural scalp laxity to accommodate that change.
Back of the head or occipital augmentation is usually best done by a custom implant made from a 3D CT scan. Although I have done enough of these surgeries to have a ‘stock’ set of implanted designs from prior patients that can be used which does not require a preoperative 3D CT scan. Either way it takes about 3 weeks to have the implant made and ready for surgery.
Patients from other states or countries usually return home within 48 to 72 hours after occipital augmentation surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull augmentation or skull reshaping, I don’t know which is the right term. I feel it’s from the back of my head circumferentially around the sides. When I push fthe ront of my hair up (to increase volume) I feel my face looks normally. But when I take my hair tightly I feel my head is smaller than my face.
I am really sad and frustrated. I feel there is no way that I can feel normal I even went to a good plastic surgeon for a consultation but after 5 minutes he said it’s genetics and not worth it to be corrected.The only doctor that I found is really supportive is you.
I think my problem is more than just cosmetic, I I don’t look normal and I cannot do normal activities like swimming. I always have to use many clips to push my hair up.
I really appreciate your kind support.
A: Your description of your skull/head shape problem is one that I have heard from female patients many times. The skull size descriptions and their aesthetic concerns and psychological effects are identical. Their is a solution to these skull size concerns and it involves a custom skull implant that adds volume to the head in exactly the areas you feel are most deficient. But there are two ways to use such a custom implant and they will create different results.
Having had patients just like you I have a good feel for the amount of additional skull volume you need. Thus the ideal approach is a two-stage one. The first stage is the placement of a tissue expander for 4 to 6 weeks to create the scalp stretch that is needed for the size of skull implant that will create the ideal result. The second approach is one-stage with the placement of a smaller skull implant without doing scalp expansion first. The way to think about choosing is what type of result are you willing to accept for the effort invested? If you can live with improvement and 50% to 75% of the ideal result then place a custom skull implant without scalp expansion. If only the ideal skull height/shape increase will do the do the two-stage approach. Be aware that once you have an implant placed you can do not do scalp expansion later. (should one decide afterwards that they want more volume. Obviously the one-stage approach is quicker and costs less…but you have to be prepared to accept improvement in skull size but not perfection.
Dr. Barry Eppley
Q: Dr. Eppley, I just Skyped with you on Friday about the procedures that I need to have done on my forehead (forehead reduction) and the occipital bone. (occipital implant) I am going to call on Monday and pay for the implant so we can start the process for it to be made. I just wanted to know what your idea was for the shape you were thinking would make a difference. I know my head is way too small for my face, so I would like it to be as big as possible and go all the way down the sides of my head and the back at the crown and come up all the way to my forehead if that is possible. Like you said without looking at my CT scan it is kind of hard to really see what the problem is at the back. But looking at the 3D CT scan you would be able to see how much forehead reduction is needed and how the rest of the skull could be augmented to match. Also just out of curiosity what is the implant made out of? Thank you again for talking to me. I look forward to having this done. I think it could change my life.
A: All custom skull implants are made of a solid but soft/flexible silicone material. Having done cases similar to yours before, I envision a horseshoe-shaped implant that augments the back and then wraps around the side of the head coming forward almost to the forehead. Just as you might imagine it is how it would be designed. The 3D CT scan will allow the fine details of extent and thickness to be worked out. Once you see the PDF file of the initial skull implant design it will become very clear to you as to how it would look.
Dr. Barry Eppley
Q: Dr. Eppley, I have a flat area on the back of my head exactly like the picture you have on your website and have attached it so that you can see what I’m describing. If you can, even though you haven’t been able to see the back of my head in person, could you give me an approximate cost for the type of procedure to correct this? Please let me know if you need any additional info. I’m 50 years old and in good health. Thank you.
A: Such an occipital augmentation can be done using a skull implant made of silicone that is created one of two ways. The picture you are describing is that of an actual custom made occipital implant from the patient’s 3D CT scan. One could argue that is the ideal way to do the procedure. The other approach is to use preformed occipital implants that I have developed in different sizes as an off-the-shelf option that avoids the need for a 3D CT scan and is done at a lower cost due to being performed and not custom made.
I will have my assistant Camille pass along the costs of both occipital implant augmentation approaches (preformed and custom skull implants) to you on Monday.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting a custom skull implant made for the back of head to correct its flatness. But I have some basic questions if you don’t mind about the process and how it all works as well as some question about the surgery itself.
1) How many times do we physically have to meet? How many trips will I have to take to your office?
2) My biggest concern is that the implant has be made exactly to the specifications and contours of my sKull so that there are no “pockets” between my skull or the implant (no matter how small or microscopic, i don’t want to risk complications) I want it to fit “like a glove.” Will the implant be custom made at the time me meet? After? Will I have time to see and try the implant, (meaning see how it fits on the back of my head by actually applying it on my head externally?) How will I know what the final result will look like? How accurate are the computer models?
3) How are the implants designed? Can you tell me more about the process and steps? I.e: we meet, you take measurements of my head, look at CT scans, and send info out to the lab where its made? What is the actual process from the moment I agree to surgery
4) What complications (if any) have you had in the past with surgery of this nature? How many patients needed revision or had complications?
5) What are the risks or side effects post op? What should I expect? How long is recovery and healing time? How long does it take for the scar to heal, or for any swelling to go down? Is there a high risk of infection?
A: In answer to your questions about a custom skull implant:
1) The only times we really have to meet is the day before surgery when you come for your surgery. Any followups are done by phone or Skype.
2) The implant will be made off of your 3D CT scan (which you can get in your local community). It is made by a computer design process to the dimensions that I provide. This way it will fit perfectly, like a cap on a prepared tooth. This is all done before surgery and does not require you to be seen. During the design process I will provide with the PDF files so you can see exactly what the implant looks like and its size. This process takes about 3 weeks to make once they (Medical Modeling, Golden Colorado) get the CT scan.
3) As above. It all starts with you getting a 3D CT Skull scan.
4) I have done many custom implants and skull augmentation with implants and bone cements. The only problems that I have seen are aesthetic…was it big enough? was it smooth and symmetric? My experience shows about a 10% risk of a revisional surgery for some aesthetic adjustment. In the case of a computer-generated skull implant, the computer design process helps avoid most of these aesthetic issues. I have yet to see an infection or any significant wound healing problem.
5) Other than some swelling, most patients do not have much pain. There are no restrictions after surgery and one can return to any activity as soon as they feel like they can. The incision heals very quickly and, even with swelling, most people don’t even notice it since the head shape just becomes more normal. In rare cases, some swelling may go forward to the eyes but that depends on how much scalp dissection is needed.
Dr. Barry Eppley