Q: Dr. Eppley, I am writing you in regards to my daughter is now two and one-half years old. The back of her head is flat (plagiocephalus) and asymmetrical (1cm difference). According to the doctors there was no need to treat with a helmet. Still the deformation is quite obvious. Is there anything that can be done about it at your clinic? I suppose she has to wait until she is 18 years old?
A: At this age, there is no form of helmet or external molding therapy that will change the shape of the skull. It is too thick at this point to be externally molded. It can be treated for its cosmetic deformity by an augmentation cranioplasty on the flattened side. That can be a very effective procedure and in some cases this is done by an injectable cranioplasty approach. This is probably the ideal procedure for plagiocephaly deformities that are mild to moderate. In laregr degrees of flattening, an open approach is better. The question is at what age should that be done. There are no hard and fast rules about the age to do this procedure. That is a personal choice of the parents. I have had requests to do them as early as age but the timing of cosmetic correction of a plasgiocephalic skull is psychological not physical.
Dr. Barry Eppley