Your Questions

Q: Dr. Eppley, I am interesting in a skull reshaping procedure for a flat side to the back of my head. In my pictures you can see the difference between the two sides of the back of my head. I want to see if you could make the smaller side of my head (left side) look the same as the bigger side (right side). My ear on the flatter side also sticks out nore. Even though it would cause me to have a large looking skull I wish to find a sense of normalness.

A: Thank you for sending your pictures. You have a classic case of plagiocephaly with left occipital flattening and contralateral right frontal flattening. (cranioscoliosis) The skull reshaping treatment for it is an occipital augmentation on the flatter side. The protrusive ear can be set back in a more traditional setback otoplasty with conchs-mastoid sutures. I assume when you mean ‘make the smaller left side of my head look the same as the bigger right side’ you are referring to using a standard/semi-custom implant or bone cement to do so. I think I would use one of my preformed occipital implants that I use for plagiocephaly cases. It is not as perfect as a truly made custom implant from a 3D CT scan but it can make for a major improvement and lowers the cost of this skull reshaping surgery somewhat.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am concerned about my lack of volume and height in the back of my head. In order to achieve a more normal look, I am considering the two step  occipital augmentation process with the tissue expander. Would this require me to take a month off of work? Have people been happy with the results? Is it possible instead to perform a series of smaller buildups to avoid having an expander in my head for a month?

A: When large amounts of occipital (back of the head) augmentation is desired, the limiting factor is how much the scalp will stretch to accomodate the bone buildup. This is overcome by the use of a tissue expander. By initially placing an expanding balloon, the scalp is slowly stretched to the desired amount. The same effect can not be achieved by serially building up the bone due to the scalp scar tissue that is created with the bone augmentation material. Most women have little problem with continuing to work through much of the tissue expander period because their hair masks much of the scalp expansion that is occurring. In the handful of patients with flat back of the heads that wanted a large amount of occipital augmentation, all have achieved greater volume and most were happy with the new shape of their heads.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am very interested in skull reshaping surgery. Since I was young I always thought my head shape was oddly shaped making it unpleasant to cut my hair short, wear hats, or even have different hairstyles. I would like to know how long you have been doing this surgery because a surgery like this can go very right or very wrong unless someone is very experienced in doing it. I know that the same surgery is also done in Korea but I would rather not go so far. I always hoped that a surgery would be able to fix my head shape, I just never knew that there were surgeons out there who could do it. My head is flat in the back and is not even symmetrically flat as one side (the left) is more flat than the other. Please tell me what you think can be done.

A: There are many options in skull reshaping surgery. I would need to see some pictures of your head shape to determine what needs to be done exactly. But by your description it sounds like a case of a flat back of the head (occipital brachcephaly) with some asymmetry to it. Thus the surgical treatment would be augmentative as an onlay cranioplasty approach, probably using PMMA as the material as the volume addition would be at least 60 grams maybe more.

I have done many such skull reshaping surgeries, and many other variations of it, for over 10 years based on a lot of craniofacial plastic surgery and biomaterials experience previously.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had skull reshaping with bone cement last year in South Korea as my back of head was pretty flat. Since then I wasnt told that much information and may have put pressure on the left side of the back of my head, and now the left side is flat. can you fix this and is it safe to re apply more bone cement on top? 

A: Since skull reshaping bone cement is permanent and does not move or degrade, the appearance of flatness on one side of the back of your head has nothing to do with what you did. (put pressure on it) This flatness has likely reappeared because all of the swelling has finally gone done and the complete result of the skull augmentation procedure is not evident. In other words, the application of the bone cement was likely not symmetric. When correcting a total flattening of the back of the head, the hardest thing to do surgically is to get both sides even. (symmetry) This is not a rare postoperative problem.

The good news is that this is a very correctable skull problem through the application of more bone cement on the flatter side. There is no problem with placing new bone cement on top of older or pre-existing bone cement in skull reshaping surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My son needs skull reshaping surgery. He is currently six yearrs old and will turn seven later this year. I have many concerns for my son. My son has never had a hair cut in his entire life. I braid his hair down in efforts to try to disguise the deformity located on the right side of his head. We are African-American and one day, after my son graduates from college, he will need to be appropriate to interview for jobs. No one will want to hire my son with braids in his hair. He needs to be able to cut his hair and wear suits proudly.  Also, both his grandfather and father are bald. What happens to my son if his hair pattern follows in that same direction? When my son was born, his head shape was absolutely perfect. I want my son to be able to fit in with society and not be ashamed or judged on his deformity. My son is an innocent child and if there were anyway I could take his place I would. Please help us.

A: Skull reshaping surgery by an onlay cranioplasty is most commonly performed for flat areas on the back of the head. I am assuming that his flatness is on one side of his head in the back of his head. Such a skull deformity is very amenable to being built up by an onlay cranioplasty procedure by putting material on top of the bone. This does require a scalp incision to do it, located more to the back of his head. He does not have to shave his head or unbraid his hair to do it. In fact, having braids in his hair is the best hair management for the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a few questions regarding occipital cranioplasty. the back of my head is kind of flat and it’s been bothering me since high school. As I get older I notice that it gradually get flatter, to a point where I don’t tie up my hair anymore because I am so self conscious about it. Now that I am 36 years old and am financially capable of fixing this problem, I am contemplating on getting the surgery done.

Below are my questions:

1. If I decide to have the occipital cranioplasty done, will I have to shave all my hair off for the surgery? 

2. Since I will have extra material at the back of my head will it affect the growth of my hair or the health of my scalp?

3. What are the possible side effects of the surgery?

4. Do you have patients who already had the surgery done for solely aesthetic purposes? And are the cases with these patients successful?

5. Where is the best place to have the surgery done? ( country/state/doctor)

Your advise will be much appreciated.

A: Thank you for your inquiry. In answer to your questions

1) No hair is ever shaved to perform an occipital cranioplasty.

2) Any placement of material on the skull bone does not affect the growth of the hair or the health of the overlying scalp tissues.

3) While infection is always a concern when any material is placed in the body, that is not a problem I have yet seen in cranioplasty. The most common side effects for any form of cranioplasty are aesthetic is the material smooth, even and symmetric? Was the buildup enough?

4) Most skull augmentations that I perform today are done exclusively for aesthetic purposes. The most common type of aesthetic cranioplasty that I perform is to treat a flat back of the head.

5) I can not speak for who else in the world performs aesthetic cranioplasties, I only know that I do.

Dr. Barry Eppley

Indianapolis, Indiana