Q: Dr. Eppley, I read about your method of skull surgery. I am a young man with male pattern hair loss. Since no real cure is available I think I should just cut it very short or even shave it. The problem is that I have a skull indentation. I have never heard of this treatment. Should I go to a plastic surgeon or to a neurosurgeon to get some advice on this matter? Since I deliberately do not cut my hair that short for it to be noticeable I could not take a picture of it where you would be able to see it. I have attached a picture of a human skull and circled the area. It is an oval shaped indentation about 2″ long or thereabout and slightly less wide. It is at the part of the skull that is bending towards the top of the head. For this reason it is noticeable even though it does not appear to be a very deep indentation. I hope you are able to get a general idea of what I am talking about.
A: The relatively small skull indentation that you have is ideal for the minimal incision/injectable cranioplasty technique. Using Kryptonite bone cement, it is injected into the indented skull area after the scalp has been elevated. This is done through a very small incision of less than 10mms. Once the cement is injected in a putty state, it is molded from the outside until it sets firm, a process that takes about ten minutes from injection to set time. The trick to this technique is to get a smooth result that is not overcorrected.
Dr. Barry Eppley
Q: Hi Dr Eppley, I was also wondering about the possibility of injectable kryptonite cranioplasty for plagiocephaly. I live in Europe and had not heard of this procedure until coming across your website. I am a 30 year old man, and my skull is flattened at the back, and a bit asymmetrical. I would be interested in the procedure, but as I understand it is fairly new. I was wondering about any other potential problems- for example, would there be much loss of sensation/feeling at the back of head? or risk of any possible future complications?
A: The injectable Kryptonite procedure is one I have been doing for the past 6 months or so. The material is not new but the method of delivery is one that I have developed specifically for onlay cranioplasty. It is a simple technique that does not permanently change the feeling in the skin of the scalp. The only potential complication has been that of smoothness of its contour, particularly at the edges where the material has to blend into the surrounding skull bone. I have seen that and also developed a relatively simple rasping remedy, which like the original injection method, uses a very small incision(s) for access. So the significant risk of the procedure may be the need for secondary or revisional smoothing if any irregularities develop.
Dr. Barry Eppley
Q: You have mentioned that there are some risk with smoothness issues with injectable Kryptonite cranioplasty. If the cement were to not feel smooth once set, could it still be smoothed out later? Is there a more appropriate age to do the kryptonite procedure? Is 4 years old too young to have it done?
A: Like all plagiocephalies, there are numerous other skull deformities as well. Your son is no different is that he has right occipital protrusion as well as his left occipital flattening. The back of his head is asymmetric as a result of both and not just the flattening alone. But since it is only practical through a limited incision approach to do augmentation, all that can be done is to build up the flatter left side.
During surgery, the molding of the material is done externally until it feels smooth, But since you can’t see it, it is impossible to know absolutely for sure. One can tell what the final result will be about 6 to 8 weeks after surgery when the swelling has subsided and, most importantly, the scalp skin has shrunk down and become adhered to the material and skull bone. Then you can feel the final result with certainty. If any irregularities or edges can be felt, secondary smoothing can be done through the same limited incision using shaping rasps just like we use in smoothing the nasal bones during rhinoplasty.
The age in which to consider the procedure is entirely open to debate and is more psychological than chronological. One can have the procedure when they are certain the skull is no longer substantially changing and the parents think that it is in the best interest of the child from a self-image and social interaction standpoint.
Q: Hi Dr. Eppley, my question is about the Kryptonite used on plagiocephaly. My 3 yr old son has plagiocephaly with a very flat head which is a little asymmetrical. I have been told that his head is still growing and changing and that it could improve, but I don’t think so. In the past year and a half it has actually gotten worse. I want to know with his head shape if Kryptonite could be a great option for when he gets a bit older. Also are there any side effects? Does it cause irritation of the skin rubbing on the Kryptonite? His head also has a bit of slopping and is more narrow towards the front of his head. I’ve attached photos. Also with the amount of Kryptonite, how much would you say for his case if he is a good candidate for the procedure. Thank you!
A: Injectable Kryptonite cranioplasty can be a good option in the treatment of plagiocephaly because it helps build out the flatter side of the skull through a minimal incision approach. It is an onlay cranioplasty technique that causes no irritation to the underlying bone or the overlying skin. The biggest risk of this cranioplasty method is some irregularities of the augmented area given that it is done without visible molding or contouring of the material. In looking at your son’s photos, I would estimate that the total amount of material needed is about 10 grams, at most 15 grams. The material does expand as it sets so less is always needed than one thinks.
Q: How much would the injectable Kryptonite bone cement option cost. A ballpark figure would suffice, thank you.
A: The cost of injectable cranioplasty varies greatly based on the size area of the skull being treated and the amount of Kryptonite material that is being used. The actual cost of the Kryptonite material from the manufacturer is tremendously expensive and can potentially make up to 25% to 50% of the total procedure cost. The best ballpark that I can can give you is anywhere between $ 6,500 up to $12,500. The best way to get a more accurate answer is to send me some pictures of your skull or forehead concerns so I can see the size area involved.
Dr. Barry Eppley
What Is A Good Age To Do An Injectable Kryponite Cranioplasty For A Flat Spot On The back Of My Child’s Head?
Q: I have a son who is 5 almost 6. He has a flat spot on the back of his head due to sleeping in the same position as an infant. We were oblivious to the fact that our child’s head wasn’t perfect. Anyway we never got him a helmet and now he has a small flat spot on the back of his head. His pediatrition said that we were lucky because his flat spot is directly in the back of his skull so his head is still pretty symmetrical. His hair covers it for the most part–but I would love to be able to fix this flat spot for him. That way he can shave his head if he wants without fear of ridicule. Since he is only 6, and I have read that the skull continues to grow until you are 8, would it be best to wait until he is atleast 8 years old? Your advice please. Thank you!
A: A simple injectable cranioplasty approach is certainly appealing for cosmetic flat spots on a child’s head. (occipital plagiocephaly) While I haven’t seen any photos of your son’s head, he seems like a reasonable candidate. The age at which to do it beyond 6 years of age is solely driven, in my opinion, by parental/patient desires. The skull’s growth cycle slows down appreciably by this age so whatever contour is obtained should simply grow with his remaining head growth without change. Remember that the implant material is sitting on top of the bone, not in it, so it is just being pushed out with the remaining skull growth.
Dr. Barry Eppley