Your Questions

Q: Dr. Eppley, I have read on your website that it is sometimes possible to remove about 5mms or so of a skull protrusion. Is this sometimes possible with a protrusion on the back of the skull? I have attached some pictures that will hopefully be helpful. I don’t think of it as a knot but a protrusion as the angle isn’t that sharp and it is wider.  I have a long, oblong shaped head, so the protrusion itself isn’t the only concern but total length. The rough price approximation on your practice’s website  would not be too great of a burden so, depending on the safety risks, even a very modest decrease of the 5 or 6 MM mentioned on your website would, at least in this early stage, seem like something to me that would be worth the cost. Thank you.

A: Thank you for sending your pictures. They show well the broader occipital protrusion. That whole area can certainly be reduced by probably up to 6 to 7mms. That doesn’t sound like a lot but, because of its broader area, will make a bigger difference in appearance than that number alone suggests. The biggest issue is not whether the occipital reduction procedure will make a difference but whether the fine incision to do it will produce an acceptable scar. It has been my experience that these type of scalp incisions do heal really well but it is always an issue to consider in a man who shaves his head.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, I am curious about my options regarding skull reduction surgery. I believe I have a pretty normal skull shape but I’d like to smooth down the bump on the lower back of my head, I believe it to be the occipital although I’m not certain. From where the top of the back of my neck transitions to the skull it seams like a bit more exaggerated of a curve than normal. I was curious if it would be an option to smooth it down, if allowably possible. Let me know if you have any questions or what you would initially require in order to assess. I would be willing to take an X-ray or CT scan if necessary. Thanks.

A: The prominence of the occipital bone can be burred down, usually about 7mms across its entirety based on its inherent thickness. The question is not whether it can be done but whether enough can be safely removed to make a difference. That can be simply answered by a plain lateral skull x-ray which will show how much skull reduction can be obtained by the removal of most of the outer cortex. It is not advised to go past the outer cortex of the trilaminar skull layers.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in skull reshaping reduction of the size of the back of my head. For a long time, I have had a distressing issue with the prominence of the back of my head in what I believe to be the occipital bone region. The problem is primarily located slightly right of centre of the back of my head. In other words, from side view, my head sticks out more on the right side than it does on the left and the bone can visibly be felt as thicker and more protruding. It also doesn’t help that my crown area feels very flat and almost leads into a boat shape back of the head. After much research, I do not necessarily believe that I have a form of craniosynostosis, though I am not ruling out the possibility of perhaps a mild manifestation of it.

As a young 25 year-old man, are there options out there for me to possibly reduce the ‘sticking out’ of the back of my head, so that I can have a more ‘normal’, flatter back of the head? I have attached two photos, taken from either side of my head, so that you can notice how one side sticks out more than the other (though my occipital bone in general sticks out much more than normal). I also appreciate that it may be hard to tell by the photos because of my hair coverage, which I keep as an attempt to mask the bumps. I understand that things of this nature are usually dealt with more in children but I came across your site when researching possibilities for occipital reduction.

A: Skull reshaping of the prominent back of the head is very common in my practice. It is never a question of whether occipital bone reduction can be done, it is always a question of whether the reduction achieved will be significant enough to justify the effort. As a general rule, 5 to 7mms of occipital bone can be reduced. That may not sound like much but usually produces a noticeable size reduction. Just based on your description of the problem, it sounds like this amount of reduction would be adequate to make a difference in your back of the head shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in 1) reduction of large occipital bone by burring and 2) forehead augmentation. Due to a narrow and recessed forehead above the brow bones, this needs to be built up with implant material. Can the scar follow the hairline if it naturally angles back laterally from the most center front couple of inches of the horizontal hairline?

A: Let me answer your two areas of concern with some general statements.

1) Reduction of a large occipital bone is always a question of how much be removed. In other words, is it worth it or not. That is best determined by getting a lateral skull film so measurements can be made to determine how much the bone can be reduced. It definitely can be burred down. The question is…is it enough to make a visible difference.

2) Forehead augmentation does require a scalp incision. generally, it is placed way back in the hairline…more than just an inch or two behind one’s existing frontal hairline. That would be particularly good if one is desiring some occipital reduction as well.

That being said, the first place to start is for you to send me some pictures of yourself for my assessment and then we can have a phone or Skype consultation for further discussion.

Dr. Barry Eppley

Indianapolis, Indiana