Your Questions
Your Questions
Q: Dr. Eppley, I am possibly interested in skull reshaping surgery. I have occipital plagiocephaly. My head is clearly flat on the back left side of my head. I am 67 years old and losing my hair which makes it more noticeable. Can surgery correct this at my age or is it too late?
A: Age is not a physical issue for this skull reshaping procedure as long as one is in good health for the surgery. Since the procedure is an extra cranial procedure (onlay augmentation), it is no more complicated to go through than many other cosmetic facial surgeries. Age is only a limitation if one decides that they are too old to care about it…then it is too late.
I would be happy to look at any pictures that show the flatness on the left side of the back of your head.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My daughter had craniosynostosis. After which she was left with plagiocephaly(right side). Was wondering what are the best options for her, she has 5mm deformity after wearing the helmet for 1 year. Now she is 9 years old. Need to know if the surgery can be done anytime or there is a certain period that is beneficial for the kids.
A: Once the skull has undergone much of its growth spurt and it is clear that ongoing growth is not improving the asymmetry, it is reasonable to consider an onlay skull augmentation. The decision to do so is based on an aesthetic judgment since there are no neurologic benefits to doing it. So the question is not whether it can be done but whether it should it be done. At 9 years of age, that is a decision for the parents to consider or to allow the child to decide for herself when she is old enough to do so.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I took my son to the Children’s Hospital to assess his deformational plagiocephaly and they told me that they would not address my son's skull deformity since it was not negatively impacting his facial features. They described the procedure as extremely painful and invasive. Where can I find more information describing the pros and cons of this procedure. I would also like to know more about the procedure itself in terms of surgery and recovery. Any information would be greatly appreciated. My son has a pretty severe flattening on the right posterior of his head. My pediatrician convinced me that helmeting was the wrong decision and his condition would improve over time. At this point, I regret listening to the pediatrician and am looking for solutions for my son.
A: What they were saying at the Children's Hospital is that major cranial remodeling surgery is not justified for a cosmetic skull deformity. That is certainly true, particularly if your son is older than 18 to 24 months old. An alternative treatment option is to build out the flattened occipital area with onlay hydroxyapatite cements. That may be able to be done in some cases with an injection technique or a small incision. This is a far simpler approach to major cranial bone reshaping and the risk:benefit ratio is much more favorable. Whether the magnitude of the occipital skull deformity justifies an onlay craniopasty procedure depends on many factors, most of which is the emotional concern of the parent about the shape of their child's skull.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi, Dr. Eppley. I have a really flat head. I can hide it by blow drying my hair, using gels and any volumizing products to make my head look not so flat. My hair is very short and has lots of layers at the back of my head so it hide it pretty well.. Is there a surgery for flat heads to make it not flat? If so, what’s it called? Have you done any surgeries for flat heads before?
A: When most people refer to having a flat head, there are talking about the back part. Sometimes it is one side but, most of the time, it is both sides. This is called occipital plagiocephaly, either unilateral (one-sided) or bilateral. (both sides) This flatness is always at the upper part of the back of the head, which is the bony or skull part. Down low, it become more neck muscle and less bone. Building this area ouot (augmentation) is done the same way as it is in the forehead through an onlay cranioplasty technique. This is done by adding a bone-like material onto the top of the bone in the amount that will satisfactorily expand out the bony contour and make it more rounded. The critical decisions about occipital cranioplasty is what type of incision to place and what type of cranioplasty material to use. The type of cranioplasty material influences the incisional approach. A vertical incision is used down the back of head (open technique) where either acrylic or hydroxyapatite materials can be placed. This offers the best and smoothest shape. A smaller vertical incision can also be used (endoscopic or injection technique) in which only Kryptonite material can be used. While offering a smaller incision, the trade-off is in the difficulty in getting a perfectly smooth shape.
Indianapolis, Indiana
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
Indianapolis Indiana
Q: Hello, I just have a few questions about a cosmetic issue that I have been dealing with for really all of my life, but just became totally aware of within the last few years. I have a condition called Plagiocephaly. I’m sure you know what that is, so I won’t go into that. I will say, however, that I have a flat spot on the left side of my head. It has caused my left ear to protrude, and my left brow ridge(the part that the eye brow covers), also protrudes. It is very noticeable, especially to me, but others do notice it too. My question is whether or not I can have a procedure done to either A.) Reconstruct the left side of my head and brow ridge so it looks more symmetrical with the other side of my head, or B.) Just correct one of the two areas. I really would like both done and I would like to know about scarring and what would they look like, and whether they would be covered by my hair or not.
A: The physical changes that you have described are classic for occipital plagiocephaly in children and adults in which the condition was not treated early or was felt not to be severe enough for traditional skull molding therapy. On the same side, one can have a flat spot on the back of the head, a brow protrusion and an ear that sticks out more than the other side.
All three cosmetic problems can be effectively treated through known plastic surgery procedures. These include an injectable occipital cranioplasty using Kryptonite material (limited scar technique), a simple ear setback (otoplasty) , and a burring down of the tail of the eyebrow (brow bone reduction) using an endoscopic technique. All three can be treated during a single operation or only the most bothersome can be treated alone.
Indianapolis, Indiana
