Your Questions

Q: Dr. Eppley, I would like to enquire about skull reshaping. I’m a 38 year old male and I remember from when I was a teenager that my skull changed shape on top. I developed a ridge at the top near the crown. It looks similar to the person on your website who you treated to reduce the height of the sagittal ridge/crest. I started losing my hair from around 18 so it became difficult to conceal this area. In desperation I had hair transplants, but they were placed in the front part of my scalp and the area with the ridge was untreated (it was the strategy in those days of using plug-grafts to place grafts in the front, in a horse-shoe shape and use scalp reduction to deal with hair loss in the crown – thankfully I didn’t have scalp reduction). So I am left with this prominent sagittal ridge. I am done with the hair transplants and just want to shave my head or have very short hair. The grafts are very irregular in their placement. I would like to know about how long  recovery in days is needed before returning home. Thank you.

A: Sagittal ridge skull reduction is a very straightforward skull reshaping procedure that uses a burring technique to reduce the height of the ridge. How far down the ridge can be reduced is dependent on the thickness of the ridge bone. It is done through a small incision at the back end if the sagittal ridge. Recovery for this procedure is very quick and many patients return home the day following the procedure…at most by the second day after the surgery. Even though there is a little swelling, it is not significant enough that anyone would know that you just had surgery. One can return to any and all physical activities as soon as one feels able.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, the sides of my head stick out and are very round. But if I pull my jaw down the sides go flatter as shown in the attached picture. Hopefully this could be corrected with some type of temporal manipulation? Also I have a pointy sagittal ridge which hopefully could be rounded off. As you can see in the attached picture if I pull my jaw down and put my hand on the sagittal ridge I feel my head has a more aesthetically pleasing shape. This in my mind is achieved by flatter sides and a rounded top of the head instead of a point. Lastly I had put a side profile as I’ve got a mild lump that sticks out which hopefully could be smoothed out . Could you tell me if these correction are possible?

A: Unfortunately your pictures are so cut off (cropped) that I can tell very little from them. But by description, temporal muscle reduction would be helpful as you can see that this is a muscular problem as evidenced by when the muscle is lengthened by jaw opening. Since it appears some of the pictures did not come through, I can not comment on the skull issues other than to say that their description sounds very typical for being capable to be corrected by bone reduction. (sagittal ridge reduction)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a skull reshaping. I am a 32 year-old man with an odd-shaped head with a prominent ridge running own the middle. While I could always feel it, it never bothered me until I started to lose my hair. Now I feel like an alien with this visible ridge on my skull. Can it be reduced?

A: Skull reshaping can involve reduction of prominent bony areas or bony buildup of deficiencies. One particular bony skull excess is the sagittal ridge or crest that occurs in the midline of the head. It usually occurs due to a mild anomaly of how the sagittal suture closes after birth. As a result it can develop excessively thickening creating a ridge or crest in the midline of the head that is especially noticeable in men that have short hair or shaved heads.

Because it is a bone protrusion or thickening it can be reduced to a more normal skull contour without risk of exposing the dura or penetrating into the brain. This procedure is done under general anesthesia through an incision placed at the back end of the crest. A scalp flap is elevated exposing the crest that is reduced with the use of a burr creating a smoother upper skull contour. The scalp tissue is closed without use of any drains and only a head dressing is used for the night after surgery after which it can be removed. These small scalp incisions can heal remarkably well.

In summary the sagittal ridge is a midline bone protrusion that can be reduced through a minor skull reshaping procedure using small scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a pointy ridge of bone running down the center on the top of my head. Therefore when you look at me face on instead of the normal curve or round shape it looks more of a point. As I have to keep my hair short this makes my head look very odd. I didn’t think anything could be done until I just saw your before and after photos which has given me a little bit of hope. I hope you can help and look forward to your reply.

A: It sounds like you have a very classic sagittal ridge from front to back, a microform of sagittal craniosynotosis if you will. The midline ridge represents either an isolated thickening of the original sagittal suture or a midline ridge combined with some narrowing in the parasagittal out towards the temporal line. In most cases, it is the combination of the two that creates the look. Improvement in shape can be done by skull reshaping consisting of either sagittal ridge reduction alone or combined with a some build-up to the sides to make for a less high and more rounded skull shape. Very visible improvement in your skull shape is possible…provided you can accept a scalp scar to do it.

Dr. Barry Eppley

Indianapolis, Indiana