Your Questions

Q: Dr. Eppley, I have a mild to moderate case of cvg (cutis verticis gyrata) that has started in the past 6 months. I have 4 very long vertical creases in my skin. Two are very long going from mid forehead to top of skull. What is strange is it doesn’t look or feel like I have extra skin on my head. They just look and feel like long large scars. In the morning apon waking they look like fresh deep scars. And at night they don’t look too bad at all. I saw your article where you discussed an alternative to normal scalp tightening surgery so I wanted to find out more about that. 

A: When it comes to cutis verticis gyrata, no one knows why it occurs or how to effectively treat it. There is not standard proven therapy for it. Cutting them out has been the only treatment that has been proposed in the past and up to the present time. But the scar tradeoff does not seem worth it in most casesand its effectiveness is poor. I have proposed doing fat injections instead to treat what cutis vertices gyrate really is…linear strips of scarred scalp tissue. The goal is to introduce healthier cells, including stem cells, into the very fibrotic scalp tissue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I came across one of your publications on the Internet regarding cutis verticis gyrata scalp condition.You recommend fat grafting to treat this condition.
A doctor I have consulted (where I am living) also recommend me to try this procedure. But I am not sure about the efficiency of this procedure. Would you mind to advise if fat grafting technique could be a good option to solve my case ? I have attached pictures of my scalp so you can have look. I am looking forward to hearing from you.

A: Cutis verticis gyrata of the scalp is a very unique, peculiar and fairly rare scalp condition. Why it is occurs is not known and how to really effectively treat it is similarly not known. The vertical grooves or grata are scalp indentations (not bone) that become fibrotic and adhered down to the bone. This adherence is quite dense and unbelievably stiff. There is almost nothing but scar tissue between the skin of the scalp and the bone. The only really viable treatment option is injectable fat grafting. Having done that procedure it is really hard to get into and raise the grata to place the fat grafts. It takes an initial release with ‘picklefork’ instruments to get the tissue separated to create the tissue plane to place the fat. And it will likely take more than one fat grafting session to get the best result. But you would have a good idea after the first treatment session of the value of doing further fat injection treatments.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, These are a few pictures of my crown and a short video of my head. The hair on the ridges is sparse but in the furrows there is some. I’m not sure if I’m losing hair in this area due to mail pattern baldness or the cutis verticis gyrata. I just want to know my options for conceiving this. Wether it be a hair transplant over it or cutting it out.

A: Thank you for sending your pictures and the video. What you should do is based on how large of an area is involved in your scalp and how progressive or stable the cutis vertices gyrate is. If the area is small and stable and is not causing any other symptoms, it be left alone. I do not think it necessarily is causing hair loss but may just be spreading the follicles out further as it expands. (although I can not say for sure whether it is) The involved scalp area should only be excised if it can all be removed and should first have tissue expansion. The scalp is not very flexible and will leave a wide scar if it is all removed at once. If the scalp area is larger and it seems to be growing, then excision would not be advised. You may consider fat injections or PRP injections in an effort to treat it although such treatment is theoretically beneficial but not yet proven.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if you have and do perform surgery on cutis verticis gyrata. If so I was wondering some of the details and and maybe some idea of the length and width of a post op scar.

A: I have performed surgery on this exact scalp condition in the past and can make the following comments about it.

Cutis verticis gyrate (CVG) is a most unusual although not rare scalp condition of which its cause is unknown. But how it presents with ridges and creases is well known and that the scalp tissue thickens to create it. Treatment options are very limited with the most common approach in limited scalp areas of excision. This may be satisfactory if the rolls are limited to the back of the scalp in a horizontal orientation. But for many cases of cutis verticis gyrata the scarring is likely prohibitive. A more innovative approach is the use of subcision (release) of the creases combined with fat injections. This ‘scarless’ approach has no real downside other than its effectiveness and would be the preferred approach in larger areas of scalp involvement in which excision is not an option.

I would need to see some pictures of your scalp CVG to see which, if any treatment options, may be worthwhile for you.

Dr. Barry Eppley

Indianapolis, Indiana