Your Questions

Q: Dr. Eppley, As for back of the head surgery (occipital augmentation) I have a few questions? 

1) how much in cm or mm can I expect the head to become rounder using implants? 

2) if the implants get infected how dangerous is it? Can it be prevented or treated?

3) Very important question – So the back of my head is flat but it is not level. The right hand side it is about 1 cm bigger than the left so basically I have Plagiocephaly and brachephly. (I think) Can a good result still be achieved and how? Are you able to shave some bone off the skull to get it to the same level and then insert the implant?

A: Thank you for your inquiry. In answer to your questions about occipital augmentation by an occipital implant:

1) Usually 12 to 15mm is the maximum implant thickness that most scalps will accommodate.

2) I have never seen an occipital augmentation infection. But the implant can be easily removed if needed.

3) With skull asymmetry the implant would only be placed on some side to have the two sides match. In these cases, the best way to make the implant would be from a 3D CT scan to get the best match between the two sides.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 28 year old male. I was always bothered by a flat spot on the back of my head. It has a profound effect on my confidence and makes me feel very self-conscious about myself. Even though it is not terribly bad, I would still like to get it corrected. Going through similar cases on your website, I would like to know if I will be a good candidate for the minimally invasive closed cranioplasty approach. What is the success rate of such a procedure? Are there any side effects? How long does it take for the scar to heal and will it be visible? How large of an incision will be needed? I have attached a photo of back of my head.  Also, my hair is currently thinning on my crown area. I would like to get an FUE hair transplant. Is it recommended to do the hair transplant first prior to the cranioplasty or vice versa? Will cranioplasty have any effect on hair growth in general?

A: The best and only way I will do occipital augmentation today is using semi-custom or custom occipital implant placed through a low occipital incision. (general 9cms in length)  This has a high rate of success (as long as one is not asking to achieve more than 10 to 15mms of augmentation) and a low rate of revision. A closed cranioplasty procedure has a high incidence of irregularities and asymmetry…which can only be revised then by an open cranioplasty approach.

Occipital implants do not cause hair loss. When it comes to hair transplantation, the impact of occipital augmentation depends on what method of FUE harvest is going to be done. If one is going to have a traditional linear strip harvest then one should have an occipital implant as least one year before the procedure to allow the scalp to relax. But one would be unlikely to get more than one harvest so ideally this FUR harvest method should not be used. If more contemporary methods of harvest are going to be used (Neograft, Artess) then the hair transplant procedure can be done six months after the occipital implant is placed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a flat area on the back of my head exactly like the picture you have on your website and have attached it so that you can see what I’m describing. If you can, even though you haven’t been able to see the back of my head in person, could you give me an approximate cost for the type of procedure to correct this? Please let me know if you need any additional info. I’m 50 years old and in good health. Thank you.

A: Such an occipital augmentation can be done using a skull implant made of silicone that is created one of two ways. The picture you are describing is that of an actual custom made occipital implant from the patient’s 3D CT scan. One could argue that is the ideal way to do the procedure. The other approach is to use preformed occipital implants that I have developed in different sizes as an off-the-shelf option that avoids the need for a 3D CT scan and is done at a lower cost due to being performed and not custom made.

I will have my assistant Camille pass along the costs of both occipital implant augmentation approaches (preformed and custom skull implants) to you on Monday.

Dr. Barry Eppley

Indianapolis, Indiana