Your Questions
Your Questions
Q: Dr. Eppley, Please help me I have flat head from the back and it looks ridiculous and people are laughing at me . And I’ve been suffering for over 22 years. I want to ask do you you have plastic surgery for the back of my head and please tell me the solution. I have attached a picture for you to see how bad it is.
A: Thank you for sending your picture. I will admit, and I have seen many flat back of the heads, that you do have an impressive one. It is one of the flattest back of the heads that I have ever seen. There is no question there is improvement to be had with flat back of head surgery, it is just a question of how much and what effort do you want to put into it. There are two basic approaches, either a single stage or a two stage approach. In a single stage approach, a custom implant or PMMA bone cement is use to create a moderate improvement. In a two-stage approach, a first-stage tissue expander is placed to stretch out the soft tissues. Then a custom implant or bone cement is placed to get a more significant change. (at least double that of the one-stage) Either way, you definitely can get a positive improvement from the very flat back of the head that you have with these occipital augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young man with a skull that is flat at the back. It has caused me a lot of grief as a teenager and to this day and I think it’s time I did something about it so I can stop being so extremely subconscious about it. I have attached pictures which show how flat the back of my head is when the hair is parted in such a way or id wet. The flatness is pretty much only isolated to the back of my head. At the very top of the head near the crown there is a noticeable ‘bump’ then the skull goes in a drastic decline. The forehead, and front sides of the head appear and feel normal/symmetrical it just the back which is causing the aesthetic issues for me.
From my research you appear to be the most qualified to do such an operation as you’ve had a great number of patients with the same issue as me therefore I would fully feel comfortable with you doing this procedure because of your extensive experience. This brings me to my next question, can you help me? From the pictures provided do you think you could give me the normal male skull I desire? There is nothing more I want than being able to shave my head really short. I understand there are different methods of operation some more intrusive than others. I am actually not concerned with the scars the operation will leave so long as it gives me the normal shape I have always desired, a skull that appears normal and wouldn’t get a second look from passers by because it’s normal. I would only want one operation to fix this issue and would like to avoid having to come back to do revisions to the operation. Now, having that in mind what type of procedure would you recommend for me?
A: Thank you for your inquiry and sending your pictures. I can clearly see that your degree of occipital flattening is significant. It is probably one of the more flat back of the head cases that I have seen. When it comes to correction, I think you have two options. First, using a standard open technique a cranioplasty can be done to build out the flat area somewhat. Stretching of the scalp is the limiting factor and you could get about a 10 to 15mm build-up. That I feel would be a mild improvement but I think is inadequate for a significant improvement. It would be better but not ideal. The second and more ideal option is a two-stage approach using a first-stage tissue expander followed by a secondary cranioplasty build-up. This could get upt to 25 to 30mm of skull expansion which ideally is what you need. The tissue expansion provides the necessary creation of additional scalp tissue to cover the size of the build-up tension-free. Computer imaging will show the differences in the result between the two approaches.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been reading on your website and found a lot of interesting information. I was looking at pictures for patients, but did not see any that resemble my condition. Do you have any with flat spots that have been filled out in the back of the head? From what I have gathered while reading your site, you can only build out up to 10 cm. I’m just trying to picture how a fix for my condition would look after. My head is normal except for the back and then it has a slope. However, the slope is not uniform. It’s less of degree on one side vs the other. So from the top down there is a slope in the back, but from left to right it is almost like it is angled. Meaning if you looked at me from the back, the right side is not as sloped as the left. In fact, the right side is a little more “normal” I guess. Thanks for your help and information.
A: The most common skull augmentation procedure that I do is an occipital cranioplasty for a flat spot on the back of the head. You are correct in assuming that the buildup would be about 10 to 12mm maximum. Much greater buildup than this may pose problems with incisional scalpclosure or undue tension on the wound which usually lies directly over it. Bony asymmetries are dealt with by a differential application of the material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a flat spot on the back of my head that I would like corrected. It is at the back of the crown of my head and it gives me a funny looking head. I have attached pictures and have drawn on them the shape that I would like to have. Can you tell me I how this can be corrected? What material and how would it be placed? What is the recovery after this type of operation?
A: Having done quite a few occipital cranioplasty procedures for skull flattening that looks just like yours, I would recommend PMMA. This is because it will take about 40 to 60 grams of material to create the desired effect. PMMA offers the most cost effective material when it comes to this amount of cranioplasty augmentation. Other material options include HA (hydroxyapatite) and Kryptonite but they will cost anywhere from 3x to 5X more in terms of material cost, that can add thousands of dollars to operative costs. The procedure would be done through an open approach through a low horizontal incision on the back of the head, where hair loss is not likely to ever occur. This is done as an outpatient procedure done under general anesthesia with an operating time of approximately 90 minutes. There is actually very minimal recovery afterwards other than some non-visible swelling on the back of the head. Occipital cranioplasty is a much simpler procedure to go through than most people envision.
Dr. Barry Eppley
Indianapolis, Indiana