Q: Dr. Eppley, I been looking Into skull reshaping procedure for years now, and your website has been very helpful. But I need the back of my skull shaved down but I can’t find no information on numbness? So do this area come with numbness and if so long long can it last?
A: Every time a scalp flap is raised to perform any skull reshaping procedure, whether it be augmentation or reduction, there will be some numbness that will occur over the raised scalp flap areas. Most of this numbness is temporary and is self-resolving over time. I have yet to have a patient tell me that they have any bothersome numbness on the back of their head after any occipital skull reshaping or reduction procedure.
On the back of the head coming up from the sides at the base of the skull are the greater occipital nerves. They supply a lot of the feeling across the back of the head as well as coming further forward along the scalp. These nerves run above the bone in the soft tissues of the scalp. Any type of skull reshaping procedures raises the entire scalp off of the bone, thus the nerves are protected from being injured or cut which would be a cause of permanent numbness.
Dr. Barry Eppley
Q: Dr. Eppley, On your website you seem to do plastic surgery related to skull reshaping. Has there ever been a case where someone had macrocephaly or a head circumference of 24.5 inches where you reduced this to 22 inches? I don’t think burring would accomplish that much. Would a craniectomy (or removing part of the skull) accomplish this or is that too dangerous. I have been able to reduce the size some myself by constricting and applying pressure to the scalp from different angles in a similar way a baby is fitted with a cranial mold.
A: The simple answer to your skull reshaping question is that burring is all you can do. You are not going to a craniectomy for an aesthetic skull size concern for a number of reasons including surgical risks, bony irregulatiies and, if nothing more, sheer cost. That is an operation that will cost $50,000+ to do with a neurosurgeon.
No one is able to have their skull reduced by 2 inches or more in circumference even with a craniectomy. (you have forgotten to take into account the space the brain needs which will tolerate no inward push)
Whatever reduction you have obtained by ‘compressive wrapping’ of the scalp, burring reduction will at least do that if not more. But burring reduction is the only aesthetic skull reshaping option you have.
Dr. Barry Eppley
Q: Dr. Eppley, I am trying to figure out if there is a cosmetic surgery that exist for skull reduction. I am a female with a 25.25 inch head circumference and it has been the joke of my life since birth. I already have to have jaw surgery because of my underbite, but I am praying that maybe there is some way to make my bobble head less noticeable. I tried gaining weight so that the weight could bring proportion, but unsuccessful. I know that this may sound silly to some, but this is my life and if I could change this, I will. I don’t expect to ever wear a hat, but I would at least like to face the public without having to cover my head with long hair or look down while walking.
A: There are a variety of skull reduction procedures that can done for just about anywhere on the skull. What is important to understand about them is that they treat selective areas which can be used to change some of the contours of the skull. In rare cases, there is even overall skull reduction by burring. These procedures can not, for example, take a 25 inch circumference of the skull and make it 21 inchs around. But in many cases they can make a visible difference which could provide a psychologically substantial improvement in how the patient sees the size of their head.
Whether these type of skull reduction procedures may be of benefit for you would require that you send me some pictures of your head for my assessment.
Dr. Barry Eppley
Q: Dr. Eppley, I am contemplating seeing you for sagittal ridge reduction surgery. My understanding is that the resultant scar will be 5 to 7cm in length, from left to right, at the crown of my skull. I am Caucasian with “medium” toned skin. While the prominence of the sagittal ridge bothers me tremendously, I’d like to get an idea of how well the scar will heal in order to determine whether surgery will be worth it. I’ve done an Internet image search for “scalp scars” and the search returns pictures from hair transplantation surgeries, brain surgeries, etc… A lot of these scars are quite prominent, and it’s difficult for me to figure out what a “fine line” scar actually means in my case. So my questions for you are:
1) How well do sagittal ridge surgical scars heal compared to other cosmetic surgical scalp scars? Since the surrounding skin is tight at the crown region of the skull, I’d expect there to be tension on the scar, which would make it wider. Is that true?
2) What can be done, if anything, to improve the scar once healing has occurred. Is Fraxel effective? What about other dermatological techniques? Are there concealer creams that can be used on a daily basis to hide the scar?
3) Do you have more before/after pictures of scars that you can post?
A: Your questions and concerns about the scalp scar from skull reshaping surgery is understandable and appropriate given the elective aesthetic nature of the surgery. Searching the internet will not be helpful since just about every surgical scalp scar you see is not what scars from this type of surgery will turn out. There is no comparable other skull/scalp surgery to which this applies. In answer to your questions:
These type of scalp incision usually heal remarkably well and ion many patients can be very hard to detect. These are not scars in which there is any tension since this is a reductive operation not an augmentative one.
There will be no scar treatments that are needed. I have yet to do a scalp scar revision from one of these surgeries as they heal so well. I do many skull recalling surgeries on bald/shaved men and the scar is usually very slight at worst.
Attached see an example of a scalp scar in a shaved head male who had sagittal ridge skull reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I am struggling with my confidence as a result of having a big head. I have read lots of articles on your webpage, and I would really like to do have something done with my head size. It is basically just big in every dimension. So I would like to do these surgeries:
1. Narrowing of head. (Partly removal of the temporal muscle and burring of bone)
2. Shorten the length of my head from my forehead to the back of my head.
3. I would like to reduce the height of my head. (For instance by burring down the sagittal ridge)
I have always had a quite big head, but I was involved in an accident recently, which provoked a bump on the back of my head. So my questions are, how much would it be possible to reduce the skull in the questioned areas?
A: You have highlighted the five site specific skull reduction locations (front, top, back and sides) where reduction procedures are possible that can have an effect on overall head size. It is hard to put an exact number or percent as to how much head size reduction would result from these collective efforts Since every patient is different with varying amounts of head size protrusions and bone thicknesses, each case has to be evaluated on an individual basis. The question is not whether one can perform all these skull procedures but whether the end result justifies the effort. I would need to see pictures of your head from different angles to provide an answer in your case. Ultimately a CT scan is needed to assess the thicknesses of the bone and muscle which also helps in making that determination.
Dr. Barry Eppley
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
Q: Dr. Eppley, I asked you about my skull shape problem before but I don’t think I’ve describe it accurately.The problem with my “big head” has been troubling for years and I hope to resolve it once and for all.
Here is my problem:
My head looks normal when viewed from the front or back. But when viewed sideways, it looks big. Specifically, the distance between the forehead to the back (the occipital region) is too large.
If one would to look at the top of my head from a bird’s eye view, the back region is sort of a “trapezoidal” shape, in that the middle portion protrudes too much out. I wonder if it’s possible to “push back” on the middle portion and fill up the side, so that the head will be a more flat or rounded shape rather than trapezoidal.
I think the only way this can be done is via a partial removel of the skull, and putting it back like a jigsaw, or maybe even replacing that portion with an artificial skull. I wonder if this is within your specialty. I heard the risk of death or disablement from this might be as high as 50% so I might not do it if that’s the case.
My goal is to reduce the said distance between the forehead to the back by 20mm. On your website, most of the skull reduction procedure I’ve read about deals with mechanically removing a portion of the skull and making it thinner. I’m not sure if that would be enough in my case. I’ve read that the human skull thicknes is only about 10cm thick at most.
A: Realistically what you are asking can not be done. The outer portion of the skull can be shaved down by removing the outer cortex. When done in the forehead and occiput, the anteroposterior (front to back) distance can be reduced probably 10 to 12mms at best. You can not remove skull pieces and put them back together any way you want because of the space occupied by the brain. This space can not be reduced or intruded upon, only the outer portions of the skull can be reduced which protects and maintains the intracranial space for the brain.
Dr. Barry Eppley
Q: Dr. Eppley, How successful are skull reduction procedures? How many have you done and what have you learned by doing them?
A: Skull reduction refers to different reductive procedures of the cranium. These can be smaller isolated problems like lumps, bumps and the occipital knob, which are usually like osteoma growths. It can also included reduction of prominent sagittal ridges and other high spots due to mild disturbances in sutural and fontanelle closure.Occasionally overall skull reduction can be done but there are limits based on bone thickness as to how substantative that type of skull changye can be. Having performed over fifty specific skull reductions of various types, I would say that they have all been successful. This is not to say that there have not been some revisions of these skull reductions to make further improvements such as smoothness and more aggressive reduction effort. But the key in skull reduction surgery is patient selection and knowing what the limits of the procedures are. You can not just reduce any portion of the skull any amount one wants. Reductions can usually only be done as far down as through the outer cortical layer just into the diploic space.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about skull reduction surgery. I have read online said that you can reduce the head. I have always been very conscious about how wide my head Is. It’s wide and big. What can you do exactly? May I send you some pics so you see what I am talking about? I also am losing hair and I read on your website that you don’t recommend the procedure for hair loss. But I am not entirely sure how you narrow the head, mine is very broad. I often wear hats because I am self conscious about my wide head and hair loss.
A: Thank you for sending your pictures and expressing your concerns. There are procedures that can very effectively reduce the size of your head including temporal muscle reduction and bone burring. (skull reduction) There is no doubt in my experience that they could change the way you see your head. However, to do these procedures one needs a scalp incision to do it and with your hair loss I would have grave concerns about the remaining fine line scar from the surgery. Thus in your case I would seriously question that aesthetic trade-off. You don’t want to trade one problem for another. While there are trade-offs in every aesthetic procedure, what one trades into should be perceived as being better than what they currently have.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping surgery. I am a 35 year old female who is concerned about head size and shape. My head is wide and big overall. Especially, the top and the sides of parietal bone are bulged so that it is really difficult to find hats to wear. I hope to reduce the top and side portions of my skull as much as possible. Having the surgery done is only way to get to rid of my life long distress. Is it possible for a patient who lives outside of the US to get this surgery done? The hardest part for me is to take a long absent from work so the time is my big concern. How many visits are required before and after the surgery? If I am sure to have the surgery, is it possible for me to visit you first time and get the surgery done in a week or so? I could possible use the weekend for before and after consultations. Another concern is that I need to visit and get through it by myself. Would that be okay?
I am sending you some pictures. Because of my thick hair, it might be hard to understand my head shape. But my hair is wet and pushed to my skull. I would not say my head is deformed. The head shape is like an apple. Both back sides of my head are sticking out. I also wish to reduce the top portion of my head as well to make my head smaller overall. Especially, the back side of the parietal region.
Here are some specific questions…I am sure you get these questions all the time.
1) What are the risks of the head reshaping surgery?
2) How much swelling will be expected? Does my head get bigger than before until the swelling goes down?
3) What will happen to the excess skin? Is it possible to cut it off? Is there any sagging skin issue after?
4) For the top and the side skull reduction how long the incision will be?
I don’t know how much physical difference you can make. But even 5 to 7mm, I will be
Sorry to bother you with many questions. Looking forward to hearing from you.
A: It is very common in my practice to have patients come from all over the world so we are very familiar with this scenario. Far away patients usually come in a day or two before surgery, have the surgery, and return home in 3 to 4 days after this type of surgery. Most do come but themselves which is why they stay overnite in the facility after surgery. Any after surgery followup is done online by email so there is no reason to return for a specific follow-up appointment. It is usually just a one time visit for the combined consultation and surgery.
In regards to skull reshaping, specifically skull reduction, the answer to your question is as follows:
1) The only risk is that there will be an incision (scar) to do the surgery and the question of how much can be reduced. (i.e., can enough be done to make the surgery worthwhile) In that regard you have made a key statement in that if even 5 to 7mms was taken down that would be viewed as an improvement. By that measurement of success, then it would be worthwhile as that is what can be maximally taken down in most areas.
2) There would be some swelling and your head would initially be slightly bigger than when you started. But the swelling is not so significantly different that it makes your head look overly big.
3) There would be no sagging skin afterwards. The scalp skin will shrink down quickly to adapt to the smaller size.
4) To get the maximal reduction of all involved areas, an incision would be needed in the more traditional coronal style, meaning a longer incision from the top of the ear from wide to side. This gives maximal exposure to do the work for the best reduction possible. It is an incision that heals well with a very fine line scar in most cases.
Dr. Barry Eppley
Q: Dr. Eppley, I have visited your website and am aware you do skull reshaping surgery. I was wondering if you could review the attached picture and can you notify me on what could be done for a skull bulge on one side that is just above my right ear.
A: The bulge to which you have shown is the temporal area which is composed of more muscle than bone. That can be very effectively reduced through a small vertical temporal incision, shortening the thickness of the muscle and reducing the bone a bit. I have done that type of skull reduction successfully numerous times. It is a short one hour procedure done under anesthesia. There is very minimal pain afterwards, no real recovery other than a little bit of swelling after surgery, and no physical restrictions afterward. It does result in a very fine vertical scalp scar measuring about 3.5 cms in the hairline.
Dr. Barry Eppley
Q: Dr. Eppley, I’m 18 and 5’6 tall and weight 130. I was born with a big head. I’m so insecure about myself seeing everyone around me with a smaller head makes me depressed. I’m planning on having a head reduction if that even exists?? The top of my head is wide and long.I have a perfect idea on what parts of my skull can be removed in order for my head to look smaller. I’m also thinking that maybe my jaw makes my head look big as well so I’m guessing you could probably help me out?
A: I often have patients come to my Indianapolis plastic surgery center asking me how to get a smaller head. Unfortunately, the reality is that the concept of skull reduction for a larger head is limited as it is simply not possible to make a big head much smaller. From your statement that your jaw is what makes your head look big, it suggests to me that your jaw is currently small or recessed. With that in mind, I would suggest that you consider a jaw enhancement procedure as opposed to skull reshaping surgery, as making the jaw bigger and more defined is a much more attainable goal. I would need to see pictures of your face/head to determine what, if anything, can be done to improve your perception of a skull-face disproportion.
Dr. Barry Eppley
Q: Dr. Eppley, I have seen that you offer skull reshaping. You said that the maximum that can be reduced is 5 to 7 mm. My question is, will that be enough to make a difference in someone who has a big head? I mean, a visual difference. Would it make a difference also when buying hats and sunglasses? I don’t expect a huge reduction, but I am just figuring out how much of a visual improvement I could expect. Lastly, if you take out the outer table of the skull, doesn’t it make it more susceptible to fractures? I would be scared to bump my head and injure my brain. Thanks
A: It many cases it can be surprising how much of a difference 5 to 7mms in skull reduction creates when done on a near circumferential manner. Given that the skull thickness ranges anywhere from 12 to 20mms depending upon the location, there is no danger of increased susceptibility to skull fracture after a burring reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I have been bullied for a number of years over the shape of my skull and I am looking to do something about it as it’s ruining my life. The width is an abnormal shape and above the ears it sticks out quite a bit. I have read some of the questions on the website and seen Doctor Eppley’s answers which seem like it would be something that can assist me. Am I right in saying Doctor Eppley is the only person in the world who performs skull reduction surgery? I have spoken briefly with someone over email where I live but I am not sure the procedure they suggested is what I am looking for. I need to find the right procedure as I feel it is a necessity to have it done to be able to enjoy my life at all. I’m so depressed about it and I’m really searching for someone to help me before I get myself in to a bigger hole with the depression.
I have attached a picture. Are you able to say whether I can be helped or not please?
How long would I need to be in hospital for and when could I travel back home?
I’m worried about the strength of my skull after the surgery, I will be able to live a normal life afterwards won’t I, like play football etc??
I really appreciate your help and you taking the time to read this I understand you are very busy. Another question is that my ears are quite pointy/large and if I was to undertake this surgery I’m worried they will stick out even more, can anything be done with them so this doesn’t happen and they look a bit more normal?
I’m so sorry for so many questions. Whereabouts on my head would the incisions be? Would they be behind the ears and would they be quite deep scars?
I had thought about hair transplants at some point in the future because my hair seems to be disappearing rather quickly but I do prefer the shaved look if I’m honest. Do you think this would be a major problem?
I have to admit it has put a smile on my face knowing that you can possibly help. From the picture do you think the 5mm-7mm you mention in your questions section on the website will be enough to make my head look more normal in terms of shape?
Thank you so much for getting back to me.
A: Thank you for your inquiry and sending your pictures. From what I can see in this one picture (which is the most helpful view), there is temporal skull/muscle protrusion as well as ears that stick out a bit. This could be improved by a combination temporal muscle/bone reduction cranioplasty combined with a setback otoplasty.
This is a procedure that is done as an outpatient and one could return home in 48 hours. There would be no worries about the strength of your skull and you would not have any restrictions after surgery.
The most relevant issue is that an incision is needed on both sides to do the surgery and this is always a concern when it is a male who shaves his head or a has a close cropped hairstyle. We just have to be careful to not ‘trade-off one problem for another’.
To be certain we are looking at the same thing, I have done some before and after imaging to see if the changes that are possible is in line with what your objectives are. This is probably what a 5 to 7mm reduction can achieve.
The incisions would be vertical in the hairline just behind the ears and extending upward about 6 to 7 cms. They are not deep or indented scars but rather just fine lines.
Dr. Barry Eppley
Q: Dr. Eppley, I have a pituitary tumor that made my skull grow very big. The pituitary tumor has been removed now and I am cured and cleared by my doctors. But the size of my skull is too big and very bothersome to me. It is very negatively impacting my self-image. My skull is too high up top and slopes down in the back. The temporal areas also stick out too far. How much skull reduction can be done to help me?
A: What I can tell you, with a lot of skull surgery experience, is that you can’t go deeper than the outer cranial table which often is anywhere from 5 to 7mms thick. Yours may or may not be thicker than that is some areas. At that point you enter the diploic space where a lot of bleeding occurs and the inner cranial table is not much further away. That is the limit of safety for any skull reduction procedure.
While 7mms may not sound like a lot of reduction, when done in a lot of areas of the skull, the external or visible appearance can be a lot more significant than the number sounds. It is common that patients think they need a lot more skull thickness reduction than they really do. I didn’t say that such a skull reduction result would be perfect or ever as much as some patients want. But is usually enough that patients feel it made a real difference.
Dr. Barry Eppley
Q: Dr. Eppley, I have a question regarding skull-shaping. I have a bump on the top of my head and the back of my head sticks out way too much. I am hoping to get these areas reduced so that my skull would have a more round shape. I want to know if this amount of skull reduction would be possible at all. Here's a picture to show you what I'm thinking, not necessarily the exact way I did it but something along those lines, what would be realistic?
A: Thank you for your inquiry. The areas of the skull that you show you want reduced can be reduced, it is just a question of magnitude. Generally speaking up to 5mms of outer table skull thickness can be reduced in most patients. Probably what you are showing is a little more than that so exactly what you are showing is not realistic But I have seen some signficant external changes occur when only 5mms is reduced, particularly when two skull areas are being reduced. That amount of skull reduction may not sound like much but often is more visible from the outside than what that number may seem.
Q: Dr. Eppley, I want to get the prominence of the back of my head reduced but I have previously had hair transplants done over six years ago. Will this prevent me from having the skull reduction procedure?
A: That is a very good question. I will assume that you have a linear occipital harvest scar now. about in the middle or lower end of the back of the head. This would be the typical location for a traditional hair transplant harvest siteIf one was trying to do an augmentation, having had an occipital harvest site would be problematic and would preclude it. But for an occipital reduction it does not. Depending upon the exact scar location, it may be able to be used for the skull reshaping reduction. and its presence would be fortuitous.
Dr. Barry Eppley
Q: Dr. Eppley, Is it possible to reduce the size of a skull/head when it is too big? My head has a circumference of 23.6 inch/60cm. I have attached pictures of where I would reduce the skull to give it a better shape.
A: Thank you for sending the computer imaging showing the areas of your skull you would like reduced. These images make it very clear your areas of concern and I will define these as three skull areas. First, on the low back of the head is the prominence known as the nuchal line. This is a naturally raised area in many people because it serves as the attachment of the neck musculature to the back of the skull. This is why it is thicker and raised. Second, there is a prominence in the bi-occipital width as seen in the front view. Lastly, there is a midline ridge on the top of the skull known as the sagittal line that is prominent giving your skull a bit of a peaked appearance.
Based on these locations and the amount of skull reduction you have shown in the images, I think that is a very achieveable aesthetic change with burring reduction in all areas. The key question is the need for an incision to get there to do it. Given that you are a male with a close shaven head, this is a serious aesthetic consideration. There are two fundamental approaches. A limited posterior scalp incision that will good access to the back of head for nuchal line and bi-occipital width reduction but a more limited reduction of the midline ridge due to the curved surface of the skull and how far the ridge goes frontally. Good access could be obtained to all areas with a full bicoronal incision but that is less desirous in a man with a shaved head.
Dr. Barry Eppley
Q: Dr. Eppley, I googled “skull reduction” and found out that you are the only one in the world who does skull reduction. I see you need a bicoronal incision for this, which is not a problem. I have a big head and can’t wear hats and I am always teased. I read that reduction is achieved throught a rotatory instrument that shaves done the external layer. You said to think about an oreo cookie. When do you reduce the skull, do you only use this instrument or you do osteotomies as well? If you burr the bone doesn’t the skull become weaker and more susceptible to fractures or soft to the touch? Do you perform a lot of these procedures?
A: In answer to your questions:
1) Cosmetic skull reduction is done by burring down the bone,, not by osteotomies. Osteotomies are major cranial bone flaps are not indicated for cosmetic improvement.
2) The skull does not get appreciably weaker with outer cranial table reduction as there remains an inner diploic layer as well as an inner cortical bone layer as well to the skull.
3) Various forms of skull reduction/reshaping are done in my practice. Whether anyone is a reasonable candidate depends on many factors and I would have to seem some pictures of one’s head to determine if they are a reasonable candidate.
Dr. Barry Eppley
Q: Dr. Eppley, I have a very large head that sticks out in the back (about one inch), is pointy on top, and comes out on each top-corner as well. This has caused me much mental distress ever since I was a chiold, and now that I am in my late twenties, and my hairline has receded a bit, I am noticing it even more. I am unable to wear most hats becuase they do not fit. I am wondering what sort of optiond I have to reshape/reduce my skull size. I don’t think there is anything that can be done to make it completely normal, but anything would be better than what it currently lokos like. I would appreciate any feedback you can give me. I have a few specific questions that I hope you can answer.
- As an African-Americn man that wears relatively short hair cuts, I ama concerned about having a large scar across the back of my skull. Are there any other otpions that would work equallya s well as an open procedure?
- What are the general costs for the procedure i m requesting?
- If an open procedure were to be done, how long of a scar would it be?
- If an open procedure were to be done, what happens to the excess scalp skin? is it removed as part of the procedure?
A: Since I have not seen your particular skull problem, I can only provide some general answers. The question will come down to…can the back of the skull be reduced enough to justify an occipital reduction cranioplasty surgery by burring? That will ultimately require a plain skull film from the side view to take a measurement and see how much can safely be removed.
To answer your specific questions:
2) Probably in the range of $6500 to $8500.
3) 10 cms. (4.5 inches)
4) A little maybe, although it usually shrinks back down.
Dr. Barry Eppley
Q: Dr. Eppley, I would to get the big bump on the back of my head reduced. It sticks out and makes my head look odd from the side. I know that bone can be shaved down but I don’t know how far or much that can be done. I did have my doctor order a skull film and the report says that the ‘occipital bone thickness is 1.7cms at its fullest’. Does this mean I can get the back of my head taken down enough to see a difference and still not injure the brain or be dangerous?
A: An occipital bone thickness of 1.7 cms is a measurement that involves the three layers of the skull. These include the inner and outer cranial table (solid bone) and an inner marrow space layer. (soft bone) Think of the skull like an oreo cookie. With a thickness of 1.7 cms, that indicates that safe cranial reduction can be done. But the real question, as you have asked, is how much could be done and would the results justify the effort. I would need to get a digital copy of the x-ray so I can take a measurement of the outer cranial table thickness and do a tracing to be sure that enough reduction can be done to make a visible difference. The outer cranial table and the marrow space can be reduced but the inner bone table can not. Assuming that each section of skull thickness accounts for 1/3 (which it may or may not), then a 2/3s or close to a centimeter may be capable of being removed in a skull reduction procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to ask if it is possible to reduce the width of head? The width of the upper part of my head above the ears is big on both sides. Is there any possibility to reduce it? I am 30 years old and it has bothered me my whole life. Thank you for taking the time to answer.
A: The thickness of the side of the heads is influenced by both bone and soft tissues. The area directly above the ears is part of the temporal area and the thickness of the underlying temporalis muscle can have a major role in its thickness. The influence of this muscle decreases as one gets closer to the transition of the skull from a vertical to a rounder more horizontal orientation as it thins out. Depending upon where the bulge or too wide portion of the side of the head is located, some reduction is possible. I have performed successful reduction in this area by releasing and resecting the posterior portion of the temporalis muscle and some outer table skull burring. This can make for a 5 to 7mm reduction per side, which could be mean up to a 1.5cm reduction in head width. If the extreme width of the head extends more superiorly, then not as much reduction can be done and the procedure may not be worthwhile to undergo.
Q: I have a question about reducing a bulge on the side of my head. I have cranial/skull assymetry and wanted to know if I can get the side of my skull shaved down/reduction a bit so I can get a more even look on both sides. The right side of my head sticks out more then my left, it’s noticible expecially because of the close cut haircuts I love to get. Is shaving down or skull/cranial reduction possible or an option? I have attached some pictures of my head from the front so you can see it. It is fairly obvious I think. Thanks, hope to hear from you soon.
A: What is you have is skull asymmetry caused by a bulge in the temporo-occipital bulge region or side of the skull. It is actually a combination of fullness of the back end of the temporalis muscle and the front edge of the occipital bone where the two actually come together. Both are easy to reduce, and need to be reduced to get the narrowing effect, and about 5 to 7mms of reduction/narrowing can easily be obtained, maybe more. There is no danger to the procedure nor is there any risk to any nerves in so doing. The issue of whether this is a good procedure for you or not is completely about the vertical scar running over the bulge to do it. The scar is the only risk in doing what is otherwise a fairly simple procedure. Given your close haircuts, it is a question of the trade-off of a more symmetrical skull versus that of a fine line scar when considering a skull reduction procedure.
Dr. Barry Eppley
Q: I was wondering if it is possible to shave down certain parts of the skull. My forehead isn’t the way I want it to be shaped. I am trying to get my forehead to stick out a little less. Is it possible to shave the skull down? And if so how much can be taken off?
A: The thickness of one’s skull can be taken done by burring. How much it can be reduced is determined primarily by the thickness of one’s outer cortex. The skull has three bony layers, an outer hard cortex, an inner spongy marrow space and and an inner hard cortex. While the burring reduction can be taken down past the outer cortex into and through the marrow space, that causes a lot of bleeding and can make for an irregular surface. Therefore for practical reasons, the outer cortex is usually the only skull thickness reduced when done for cosmetic purposes. That can vary in different skull areas but in the forehead in a man, that may be up to 5mms or so.
The more significant rate-limiting step for male forehead reduction is the incision needed for access to do the procedure. A scalp incision is needed to turn down the scalp so the bony forehead is exposed for reduction. Given the unstable frontal hairlines and hair densities of most men, forehead surgery of any kind may not be worth the trade-off of a scalp scar.
Dr. Barry Eppley
Q: Hi, After I was born, a hematoma appeared on the back top right corner of my skull (either trauma on the way out of my mom, or trauma suffered after being born…we’re not sure.). It ended up calcifying after being left untreated (at least that’s what doctors have said in the past), and to this day, the lump is still there. It’s about 1.5 inches in diameter and sticks up about 1/2 inch from my skull. This wasn’t necessarily a problem growing up, because hair could cover it up. But unfortunately, genetics have brought on the beginning stages of male pattern baldness. I’m thinning quickly, and a hair transplant seems unlikely at my age of just 23. Therefore, I would like to get used to shaving my hair down, but as we all know, people need a good head shape to pull it off properly. Another side note, but not necessarily as important: I have a prominent forehead that sticks out a bit further than the ridge of my browbone, and my temples are a bit hollowed out. I wear bangs to cover this stuff up as well, but with hair loss, this isn’t feasible in the long run. I’m not sure if these things are fixable, but hopefully I can begin to get some information on what should be done. This stuff is killing my self esteem! I’m a good lookin’ guy! I’m in college! This shouldn’t be happening right now! Looking forward to your response.
A: What you had an birth was a cephalohematoma, a blood collection under the skin and more pertinently under the periosteum of the bone. This is a well known stimulant to bone formation and they are well know to calcify. It can certainly be rather easily burred down which is a simple procedure. The key is to be able to do it with a fairly minimal resultant scar. (incisional access) Given its relatively small size, that should be able to be done with a very minimal scar of about an inch placed vertically on the back of the head at its lower end.
The forehead issues can be similarly treated through burring reduction but the problem is one of hidden surgical access. In the forehead with an unstable hair pattern in a male this is not very feasible. A long scar placed across the top of the head is not a good trade-off. Having a smoother and less bulgy forehead at the expense of a long scalp scar may not be a good aesthetic alternative.
Your temporal hollowing, however, can rather easily be improved through a temporal augmentation procedure. Dermal grafts can be placed under the muscle fascia through small vertical incisions in the temporal scalp. Rounding out the temporal area will help blend in with the forehead shape better.