Your Questions
Your Questions
Q: Dr. Eppley, I am interested in occipital augmentation surgery. My 5 year old son has a flat spot on the back of his head. We consulted out pediatrician about it from an early age and were told it would “round out”. It didn’t so at 18 months we paid out of pocket for a helmet and got minimal results because of he was passed the age of best results.
This has caused a lot of pain and regret for us even though my son doesn’t have a clue that anything is wrong. At what age is it safe to consider doing something about the issue? We don’t want him to face any social issues because of bad advice from our pediatrician and late action on our part. What are our options?
A: The aesthetic correction of unilateral occipital plagiocephaly by occipital augmentation can really be done at just about any age in my opinion. Correction involves building out the bone with hydroxyapatite bone cement (at at early age) or a custom made implant at older ages. Whatever is placed on the bone will grow with the slowly expanding skull growth. I think hydroxyapatite cement is most appropriate for young children since its the inorganic mineral content is most similar to bone. The decision and timing for occipital augmentation surgery at this point in your son is a personal one and is most appropriately done when you and your wide deem it most psychologically protective.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came across your website in search of a surgical procedure that would add more volume to the back of my head. (occipital augmentation) I have essentially a flat head, and would like to change that. My question is; what is the average price (I know they are not all the same) for this procedure.
A: The typical occipital augmentation procedure uses about 60 grams of bone cement (which is just about the extent that the scalp can stretch to accommodate the underlying bone expansion) placed over the flat area on the back of the head through a scalp incision. In most cases of occipital augmentation this produces a satisfactory result. However there are a minority of cases where this volume addition may not meet the aesthetic expectations of the patient based on the degree of flattening that they have. Thus it would be helpful to see a picture (side view) of your head to determine if this one stage approach would be enough. In more severe cases, a two-stage approach can be used but obviously we would like achieve a good enough improvement that only a single surgery is necessary.
As a general number, the average total cost of a cone-stage occipital augmentation procedure (all expenses included, surgeon’ fee, operating room and anesthesia and bone cement material costs) is around $8500.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in skull reshaping. The occipital bone on my skull is flat and I am interested in correcting this, preferably with an implant. Surprisingly, you and a Korean clinic are the only 2 places I have found so far for this procedure. I have already ready about the risks and complications for elective surgery, I have read some of your blogs and had a few other questions. How many skull implants have you preformed and what complications have you seen? Do you recommend the putty over implants or no? I would worry that the putty would cause more complications and would be harder to remove if something went wrong. How much do you charge of this surgery? How long does the surgery take and what is the procedure? Could a rhinoplasty be combined with tis surgery and at what additional cost? If I opt for a rhinoplasty, would it be better to do the skull reshaping first and base the amount rhinoplasty on the new skull shape or vice versa? Thank you for your time and consideration.
A: Skull reshaping surgery is commonly done for a flat back of the head. When it comes to occipital augmentation for a flat back of the head, there are different types of augmentation approaches as you have mentioned. Bone cement or bone putty (PMMA or HA) and a preformed silicone implant can be used. There are advantages and disadvantages to either approach. Bone cements offer materials that do bond to the bone and can be impregnated with antibiotics as they are mixed intraoperatively which are their advantages. I have yet to see an infection with a bone cement cranioplasty. Their disadvantages are that they must be molded and shaped as they are applied as a putty so they can have some irregularities and palpable edge demarcations which is the number one reason a revision on them may occasionally be done. A preformed silicone cranial implant is perfectly shaped and its flexible characteristics makes it very adaptable to the bone without edge demarcations. Its softer material also allows it to be placed through a smaller incision. But the material does not bond to the bone and ideally should be secured in place by a small titanium screw. Its infection risk is somewhat higher and it is the only cranial implant that I have ever seen develop an infection and had to be removed. (one case)
Regardless of the material, both are easy to remove and the actual material cost is not significantly different. Most occipital cranioplasties take between one to two hours to perform and total cost will be in the $8,000 to $9,000 range.
Rhinoplasty can certainly be done at the same time as any skull reshaping surgery and actually commonly done, regardless of the type of rhinoplasty needed. If one separated the two procedures, the order that are done on does not make a difference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am inquiring about the injectable, minimally invasive cranioplasty skull reshaping procedure that you mention on your website. I am in my 50s and considering shaving my head after years of trying to deal with cosmetic issues related to thinning. I have been reluctant to do so due to an uneven flat spot on the back of head until I happened upon your site that describes ways to correct it.
A: The pure injectable cranioplasty skull reshaping approach has largely been abandoned due to an inability to get it completely smooth throughout the augmented area. That has been modified to a ‘minimal incision’ cranioplasty with a small incision about 2 to 3cms long. With this more open approach the material can be placed and then more carefully smoothed at the edges so there is not a step-off between the cranioplasty material and the natural bone. This can be a very good procedure as long as the size of the skull flattening is not too big.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi, I am 25 and have a really flat area at the back of my head. I’m very self-conscious about this since I was 15. Is there any way that I can fix this for a cosmetic purpose. Can something be implanted at the back of my head? You are my only hope I have. I almost cried of joy after reading your articles that it is possible to reshape the back of my head by some materials and that you have done this so many times. This really means so much to me if I can get a new round back of the head, I will also get a new life with your help. I have attached some opictures of my head taken on the side. Whenever I look at it, i just want to cry. And I’ve mentally suffered from this flat head shape since I was a teenager. What needs to be done, and how long does it take to recover after the operation? I would appreciate your help and time so much.
A: Thank you for sending your pictures. I can see how flat the back of your head. The best and most economical way to augment and expand the back of your skull is through an onlay cranioplasty method. This involves putting a material on top of the bone to build it out. Given the amount of material needed, I would recommend acrylic or PMMA. Other materials exist but they are exponentially more expensive. There is even an injectable technique using Kryptonite Bone Cement, and that would be a good option for you, but that would be a cost issue.
Recovery from this type of surgery is fairly quick, particularly if an injectable method was used. (since there is only a one inch incision to do it)
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