Your Questions
Your Questions
Q: Dr. Eppley, I am interested in getting a skull implant. I have attached photos of my mutant head. As you can see I got this stupid bald ugly head, it is not very visible from behind but looks very bad from left or right side. It is not very much dented but it is enough and bothers me very much. So many people ask me what happened to my head or they just staring at my head like I came from another planet. Is there any way to fix it? This skin on my crazy head is kinda flexible and I thought it would be enough to pull that skin in a direction to make it less visible or apply some kind of implant under the skin to make my head more round on that flat area and cover that bump/dent. Any suggestions? How long does it take for such a surgery or some other kind of fixing it?
A: Thank you for your inquiry and sending all of your pictures. There is no question that the best and only way to get the back of head built out and smooth is with a custom made skull implant. This can be designed on the computer using a 3D CT scan of you and then inserted through a small low scalp incision to fit over the bone. I have done such skull augmentations many times. I have attached a recent back of the head case that shows how this technology works and how effective it can be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a skull implant question. In your experience how do these two materials perform in terms of edge transitions (edge of implant to the skull)? Is there a noticeable step off from the implants onto the skull on a shaved head?
A: In the shaved or bald male head, there is always a concern about a visible transition of a skull implant to the bone. Eventually any less than smooth transition will be seen no matter how thick the scalp is. PEEK implants can not be made with a feather edge to them because of the way they are manufactured. (machined) Furthermore they were never designed to be used an an onlay and the company will probably not make them knowing that it is to be used as an onlay since they are only FDA-approved as inlay skull implants for defects. Conversely silicone skull imlpants can be made with a fine feather edge by virtue of the way they are manufactured. (poured and oulled off of a mold)
In short, a silicone skull implant offers the best material capability for the smoothest implant to bone transition. In the exposed scalp patient a skull implant needs to have a virtual feather edge at its perimeter.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking a skull implant. The crown of my head is flattened out in the back and I would like to have the back of my head have a more rounded shape to it. I’m bald and wear a hair system that’s adhered to my scalp right now. But I am considering having scalp micropigmentation to give me a buzzed haircut look and the appearance of the back of my head is the only thing that’s stopping me right now from doing this. the scar which would be created can be hidden somewhat with the micropigmentation. On your website, you have a pic of what the back of my head somewhat looks like but maybe not as extreme so I have attached it so you can see what it looks like. If you need a more detailed pic, I would have to remove my hair system which would take time to remove it but if its needed, please let me know. I am hoping to get an approximate cost for the procedure if its something that can be realistically done. I don’t have enough donor hair to consider having a hair transplant and this to me is the next best option as I’ve always wanted as I’ve always loved the buzzed cut hair look. I hope to hear from you soon, thank you for your time.
A: It is extremely common in men that they seek skull implant augmentation when they are either going bald, want to shave their head or permanently eliminate the need for a hair prosthesis. The fear of what their head shape looks like may drive them to seek skull shape correction. In short, I have heard your story and motivation for skull reshaping surgery numerous times.
The best approach for increasing the convexity of a flattened back of the head is a custom skull implant. This is made from a 3D CT scan. My assistant will pass along the cost of the surgery on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a skull implant for my child. What is the youngest age you would fit a pediatric skull implant to a child? Can it be done under local anesthesia?My son is three years old.. He has plagiocephaly of 6mm and 92% brachycephaly. Would he be suitable for a skull implant? Would he need more surgery as he got older? How many children have you fitted with head implants? Many thanks for your time.
A: I have done onlay cranioplasty surgeries in children as young as 4 years of age using hydroxyapatite bone cements. I have yet to use a silicone skull implant in someone that young although there is no specific medical reason not to do so. It is just a request I have never had. An onlay skull implant would grow with the child as the bone underneath it expands outward. There may or may not be some settling of the implant into the bone a e] millimeters as the skull grows but this is a passive process not an active inflammatory or ‘erosive’ biologic event. If his occipital deficiency is 6mms I would preferentially consider preferentially consider bone cement but I am not opposed to an implant. Either way these are not procedures done under local anesthesia in children. Please send me a picture which shows his occipital plagiocephaly deformity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It’s been over a year since I had my frontotemporal skull implant surgery with you and I’m quite satisfied with how things have turned out. I have noticed however some hollowing near the eye brow roughly at the bottom edge of the temporal implants. This is very minor and I assume something like a filler or minor far transfer could smooth it out. In your opinion would it be safe to use fillers or fat around the skull implant site and its capsule?
A: Thank you for the followup and I am glad to hear that our custom skull implants efforts have come a largely satisfactory outcome. With such a large implant, particularly that extends far onto the temporal areas, it is not surprising that there might be a slight irregularity along one of the edges. I think it would be perfectly safe to use either injectable fillers or fat injections around the implant edges. As long as the capsule of the implant is not penetrated there should be no chance of infection. In order to eliminate the risk of implant capsule penetration any injection material should be done using a blunt-tipped cannula rather than a sharply beveled needle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a skull implant placed six days ago. I have a question about the result of my surgery so far. I have noticed the areas on the top front of either side of my forehead are really soft (squishy). When I press on these areas it feels like I am pressing against a small water balloon. The squishy points are along side the implant edges on the front sides of my head where I do not have any hair. This might also be the case in other parts along the edge of the implant, but I can not tell as much because I have growing hair on rest of my skull. I believe the implant is noticeable from underneath the skin at this point in the healing process. Can you please explain to me what this may indicate? Is this an expected thing at this point? or is this an indication that my implant my not be concealed and will remain noticeable going forward? Thank you.
A:This is all normal at this point in your skull implant recovery. Remember I said it will take 6 weeks for all swelling and internal fluids to be absorbed. You are not seeing the edges of the implant. Rather you are seeing the limits of the tissue dissection where the scalp has been lifted up from the bone. This goes well beyond where the implant sits on the bone. (implant pocket creation) The edges are where the scalp tissue is tightly adherent to the bone. With swelling and fluid it creates a ‘perimeter’. For this visible perimeter to go away this requires swelling and the fluid to be absorbed so the tissues stick back down. This is an issue for 6 weeks to resolve, not 6 days.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom implant in the subnuchal region of my occipital skull. I know that fat grafting is another options to augment this area due to the neck muscles attaching to the skull there. My questions are what are the possible complications could be, and if you have seen these types of complications in any of the other skull shaping patients you’ve operated on. Hypothetically, in my case, I believe that such an operation could involve clearing/removing a 2cm width band under and parallel to the nuchal ridge on one side before in order to have the implant attached. Would this have a severe effect on head and neck movement and/or cause long term pain?
If this is not a viable option I’m curious as to whether an implant could be placed in a pocket over the muscles/tendons and not directly against the skull. I have read that implants used in other areas (ie. breast implants) are at times placed within or over muscles and are not secured to any hard body structure. Could an implant be placed in the subnuchal area over the tendons, thus avoiding their separation from the skull? Subsequently if there was an implant placed this way, and if a portion of the implant extended to an area of the skull without/ not covered in tendons, could it then be attached there? Alternatively is there a method of fixation to the skull that could occur through the tendons (i.e., with screws) to secure an implant in place. I ask this after reading of non-secured implants causing erosion of tissue with micro-movement over time.
At this time I am willing and able to pursue a surgery if there could be an intervention that was safe effective visually and that is stable over time. I would be grateful for any input you may have.
A: Placement of a subnuchal skull implant for low occipital/upper neck augmentation would have to be placed on top of the muscular fascia as opposed to under it against the bone. Stripping the muscular attachments off the bone is associated significant discomfort and recovery of neck motion. Once in the subcutaneous tissue plane between the skin and the fascia the implant will generate a layer of scar around it which will keep it in placed. (much like a breast implant)
The only anatomic risk of placing an implant in this area is the greater occipital nerve. Fortunately this nerve lies under the muscular fascia and does not common through until higher up over the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 68 years old. Several years ago I was diagnosed with Graves Disease and am currently in remission (forever I hope). However, due to the disease, medication, age and possibly genetic, my hair has become very fine and thinning all over. This in turn has accented my VERY flat back of the head and top. I cannot wear a headband because there is no where to hold it. The band slips off. My face looks much larger due to no balance of the skull. I will probably have to wear my hair short because it will not hold any style. So I am looking into reshaping. I am becoming more of a recluse due to this as I feel so unattractive. If you could tell me what augmentation approach would work for me. (similar to the female full back of the head that you show in your example) What also would be the most cost effective method to do it? I would certainly appreciate it. Thank you for your time.
A: Skull augmentation of the back and top of your head can be done with an implant. While a custom approach would be best using a 3D CT scan, that does add to the cost of the procedure. The most cost effective method would be with the use of preformed skull implants. Having done many custom skull implants over the years, I have a variety of preformed implants available that are close enough in shape that they would work for many other patients. By cutting peripheral slits in the preformed implants, like a fan, they can be made to lay flat and flush on just about any curved skull shape.
Dr. Barry Eppley
Indianapolis, Indiana