Q: Dr. Eppley, I would like to see the possibilities of skull reshaping surgery. I am 33 years old and have always been unhappy with the shape of my head. My head is big overall and I dislike the unusual shape and so I would like to change this for it to look more normal. I have the following concerns about my head shape: (1) It slopes down and stands tall at the back side. (2) I have a protruding knob on the back. (3) it’s wide on the sides. So please look at the pictures I have attached.
A: Than you for your inquiry and sending your pictures. I can certainly see your skull shape concerns with a very convex posterior temporal region which connects with an occipital protrusion and a higher posterior sagittal region. All three of these skull areas are really connected and part of the overall skull shape protrusion. While I think there is no question some major improvements on your shape can be made by bone and muscle reduction, it will require a full coronal scalp incision to do so. In a male with your close cropped hairstyle that always give me pause. Every aesthetic surgery involves tradeoffs and one has to evaluate the scar vs. the skull shape benefits very carefully. You never want to trade into another ‘problem’ that you may dislike just as much as what it was designed to treat.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping surgery. As you are probably aware, healthcare over in the UK is pretty much free. Cosmetic surgery is not given for free due to the fact its simply cosmetic, something you don’t like the look of on your body. If it is present from birth or is causing psychological effects, it can be done for free. I have had a very flathead from birth and it is causing me all sorts of stress and depression. Do you think the NHS (National Health Service) in the UK can provide me with help? Have you heard of anyone getting this type of surgery in the UK through the NHS? Also whom would you recommend that I go to for skull rehaping surgery in the UK?
A: I have had this question from patients from the UK many times. The simple answer is that there is no surgeon in the UK or Europe that performs these types of skull rehaping surgeries. And even if there were, NHS would consider this a cosmetic surgery just like all insurers do in the U.S.. Reconstructive skull surgery is for the restoration of skull contours for partial or full thickness bone defects. Aesthetic skull reshaping are a collection of cosmetic procedures whose purpose is to change the shape or contours of a skull that have adequate bone thickness.
Dr. Barry Eppley
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, I am inquiring about skull reshaping surgery. In my opinion I’ve got quite a bit to do on my skull as I guess about 60% of my skull needs filler. My head slopes down from the centre of my skull on the top of my head to the back of my head. Also from the back of my head to my ears has flat spots and low spots that need to be filled on both sides. On both sides of my head above my ears is needs to be filled as it slopes abit to the top centre of my head. Hope this makes sense. I can draw pictures If that helps or a Ct scan might be needed. Also I live in the United Kingdom which would mean I would have to fly over. Would that have any effect on having the operation then having to return to the UK?
A: From your pictures, I can clearly see your skull shape concerns which are located onj the back half of your head. I would not think that the skull area involved is as much as 60% surface of your head (probably closer to 1/3) but that is a moto point. Your skull reshaping needs could only be done by a custom skull implant procedure. That is the best way to smoothly and evenly augment your skull contour issues. That requires a 3D CT scan from which the actual implant is made through a computer design process.
I have many patients from the UK for a variety of procedures including various forms of skull reshaping. There are no adverse effects from air travel on this type of aesthetic skull procedure.
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 interested in skull reshaping as well as jawline reshaping. Would insurance cover my surgery since it is due to congenital plagiocephaly? Also, any doctor in my area that you know of that could do the same surgery that I need? Thank you for everything you do.
A: Thank you for your inquiry. In answer to your questions:
1) It would be impossible to answer any of your questions without knowing what exact procedures that you need. What I could envision what they may be, I would need to see pictures of your face and a more specific description of the skull and facial asymmetries that you have. Skull reshaping and jawline reshaping are broad terms that apply to a variety of different procedures.
2) Only the insurance company can say whether any of the proposed procedures would be covered. To make that determination the treating physician would have to file a predetermination letter complete with a 3D CT scan (to show the deformities) so they can pass judgment on the operative plan. At best, it would be a 50% or less chance that they would cover any of the procedures.
3) Without knowing the exact problem and the needed procedures, I could not say what expertise exists in your geographic area. Skull reshaping and jawline reshaping are very specialized areas in plastic surgery that very few plastic surgeons do.
Dr. Barry Eppley
Q: Dr. Eppley, I am interesting in a skull reshaping procedure for a flat side to the back of my head. In my pictures you can see the difference between the two sides of the back of my head. I want to see if you could make the smaller side of my head (left side) look the same as the bigger side (right side). My ear on the flatter side also sticks out nore. Even though it would cause me to have a large looking skull I wish to find a sense of normalness.
A: Thank you for sending your pictures. You have a classic case of plagiocephaly with left occipital flattening and contralateral right frontal flattening. (cranioscoliosis) The skull reshaping treatment for it is an occipital augmentation on the flatter side. The protrusive ear can be set back in a more traditional setback otoplasty with conchs-mastoid sutures. I assume when you mean ‘make the smaller left side of my head look the same as the bigger right side’ you are referring to using a standard/semi-custom implant or bone cement to do so. I think I would use one of my preformed occipital implants that I use for plagiocephaly cases. It is not as perfect as a truly made custom implant from a 3D CT scan but it can make for a major improvement and lowers the cost of this skull reshaping surgery somewhat.
Dr. Barry Eppley
Q: Dr. Eppley, I may be interested in skull reshaping surgery. I am contacting you because I have been searching for a professional opinion relating to some worries I have concerning the shape of my head, and I thought that you might be able to help. I have noticed that there is a clear ridge sloping outwards, and above that, the shape seems to be flatter than when compared to many other people I have seen.
I never used to be so preoccupied, but this changed when I recently saw my head in profile. I have begun thinking that it is not ‘standard’, and I’ve been wondering whether there may be a reason for this.
I believe that some attitudes of people towards me, in the past, have been influenced by its shape. Do you think that undertaking cosmetic surgery to correct this would be possible/advisable, based on the images provided?
I realize it’s probably nothing, but I think it’s best to be certain about something like this.
A: I can tell you whether your skull shape should be a concern to you or not, that is a personal judgment. Beauty is in the eye of the beholder so speak…in this case an abnormality is also.
What I do see is a skull shape that has a flat occiput which has resulted in the posterior sagittal ridge area being raised up and sloping downwards toward the forehead. These skull shape issues are all interconnected and they are a well known type of skull abnormality.
Whether this skull shape should be of concern to you and whether it should be corrected is a personal and aesthetic judgement on your behalf. But it can be done through aesthetic skull reshaping surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 33 year old male and am interested in skull reshaping of the back of my head. (occipital bone reduction) My occipital bone has always been really noticeable. Now I am quite bald it’s even more noticeable now. I often get remarks about it, people tend to touch the back of head to feel it, and I’ve heard people talking about it behind my back. Is it possible to reduce it? I’ve seen a similar case on your webpage.
A: The occipital bone prominence can definitely be reduced. It is only a question of how much and that would be based on the bilaminar thickness of the occipital bone.This is best determined by a simple lateral skull x-ray which will show its entire thickness and the thickness of the outer cortical table of the bone. A tracing of the occipital profile can be done on the x-rays to show what the realistic outcome would be from the procedure in the profile view.
The horizontal prominence of the occipital bone is a very common skull reshaping surgery in my experience. It involves making a small horizontal incision on the back of the head from which the occipital bone is burred down as much as possible. It is usually not possible to over reduce or due too much of an occipital bone reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I was reading the information over skull reshaping in the site and I noticed that the procedures for narrow skulls are usually done with infants or toddlers but my question is if it were anything that could possibly be done to a 20 year male skull? My skull isn’t exactly large but very narrow and long.the reason I’m asking this question although I am aware that this procedure is most common for toddlers is because I research a few before and after pictures on give and I noticed that some of the males appear to be in their mid 30’s or so. I’m praying that anything could be removed or reduced from the front or back of my skull to make it appear at least close to normal if I am fortunate enough to have this procedure done. Please feel free to contact me anytime of the day. Thank you
A: While the most common treatment for a congenital long and narrow skull is complete calvarial remodeling or suturectomy of the sagittal suture, that is for the infant condition known as sagittal craniosynostosis. That type of surgical approach has nothing to do with treating a long and narrow skull in an adult. Such treatments can only focus on camouflage efforts on the outside as the brain is no longer growing and occupies a fixed space on the inside of the cranial ‘box’. Whether these adult efforts at skull reshaping can be done with frontal and occipital bone reduction (which is limited) and/or widening in between the front and the back awaits analysis of your skull shape. PLease send me some pictures of your head at your convenience.
Dr. Barry Eppley
Q: Dr. Eppley, I want to ask you a few things about skull reshaping.1) Can you reshape a skull that its parietal bone is not curved but straight down towards my forehead? 2) Can you implant a flat back head to be curvy? 3) Can you narrow the side head? My side head is over widened till its not a straight, smooth to the back. 4) Are there risks for death if this surgery is done (with jaw angle enhancement)? 5) How much will all of the surgery cost? I wish you could reply my questions to my email. Please reply, thanks.
A: In answer to your skull reshaping questions:
- You can reshape the parietal bone so that it is straighter and not so curved.
- An implant can be placed on the back of the head to add projection.
- The side of the head can be narrowed by a combination of temporal muscle reduction and bone thinning.
- There is no risk of death by combining skull reshaping with jaw angle augmentation. Skull reshaping is a perfectly safe aesthetic surgery that should not be confused with its very distant cousin in Neurosurgery of craniotomies.
- I will have my assistant pass along the costs of the surgery to you tomorrow.
Dr. Barry Eppley
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
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
Q: Dr. Eppley, I want to ask about the skull reshaping using the bone cement.
1- what are the side effects, honestly?
2- how much will it cost?
3- if i want to do a hair transplant shall i do it before the head surgery or it doesnt matter and i can do it after?
4- can the doctor show me how my head will look in a computer before the surgery?
I really hope I hear these answers from the doctor himself.
A: To properly answer your questions, I would need to see some pictures of you and know exactly what you want to change in your skull shape. But to provide general answers to your questions:
1) Other than some type of scalp incision (scar0 to do the surgery, the only other side effects are how well is the goal achieved, is it smooth and is the result symmetric.
2) I would need to see exactly what needs to be done to give you an accurate cost of the surgery by sending some pictures of your head.
3) You should do any hair transplants AFTER skull reshaping surgery.
4) Pictures would be needed to see potential surgical changes by computer imaging.
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, I have some questions about implants for skull reshaping. These are the questions that I would like for you to answer. Thank you for taking the time to answer them.
1) My main concern is to eliminate the cone shape at the top of my head. It appears that using implants would give me better results than just burring the scalp. Which one of the two do you believe would give me the best possible aesthetic look? Meaning the most proportional/normal looking head? If I can achieve a normal shaped head, “with implants only” I do not see the need for you to burr the scalp. However, if you believe that implants “alone” cannot give me the best possible shaped head, I would go with the option where you burr and insert implants. I don’t think I would have a problem with the height of my sagittal crest if the sides of my head would not be so slanted.
2) If you only use implants and do not burr the skull down, would this create too much tension on the top of my head? Will the skin on my head once pulled over the implants create too much tension that would then lead to pain in my head?
3) Am I going to be limited in the kinds activities I could take part in? For example, would an activity like diving head first into water be considered unacceptable for fear that the implant will move out of place?
4) Does this procedure require maintenance? Will I have to replace the implants after time goes by? Or can I can I live out my life without having to worry about it again?
5) What kind of material are the implants made from?
6) How long until the scar is completely healed, or the time frame when I will know the scar will look as good as it’s going to look?
A: 1) That is why I do computer imaging to look at all options available for skull reshaping. By looking at the head shape outcomes from all three methods, YOU can make that determination. This is a purely aesthetic judgment of what you think looks the best.
2) No, The skull implants are not that big.
3) No, you would have no physical restrictions and they will not become displaced no matter what you do.
4) The skull implants are permanent and will never need to be replaced.
5) They will be custom implants made of solid silicone elastomer and will feel just like bone.
6) Scars take put up to six months to fully mature. Although many scalp scars do well and mature before that time period.
Dr. Barry Eppley
Q: Dr. Eppley, I am a young man with symptoms of moderate plagiocephaly. The left-back side of my head is flat, the left eye and cheekbone is slightly higher and more prominent, my right eyebrow is lower and the eyelid sags heavily compared to the left, my right ear is pushed outwards and pulled back compared to my left one, and my jaw is wider on my right side. I noticed this completely about a year ago but most of my life I have felt like there was something off about my face. I’ve never been “bullied” by my appearance but I’ve been told from friends that I have a weird head or crooked eyes. Most people probably don’t notice right away but I feel like it is holding me back from completely enjoying my life and being content with my appearance. For example I cannot wear glasses because they look crooked when I put them on and I’m afraid to get a haircut because it is very noticeable how much larger the right side of my head is than the other.
A few potential surgeries in helping my appearance maybe be augmenting the left back side of my head, reducing some of the thickness on the right side by burring the bone and removing some temporalis muscle, adding prominence to my right cheekbone and filling out my left jaw. I’m not looking for perfection, but I feel that adding and taking away from the right spots and micro-adjusting my features would help me look a lot better.
I’ve done quite a bit of research on my condition but I cannot find any clear answers on what would help me. I would greatly appreciate any input you have on how I could improve my facial balance and asymmetry and bring out the natural good looks I believe I deserve to have.
A: Without seeing pictures of you I could not make any specific recommendations, but all the face and skull procedures you have mentioned are classic ones for correcting craniofacial plagiocephaly issues. (crooked face and skull) Occipital augmentation of the flat side of the back of the head and burring reduction of the contralateral protruding side of the back of the head are good skull reshaping options. Unilateral cheek augmentation and unilateral jaw angle augmentation are good facial ershaping options. Since you have identified those areas they would undoubtably all be collectively beneficial for improved craniofacial symmetry.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping surgery. I think I have scaphocephaly but I’m not sure. My head shape looks like those of the kids in the picture when I was younger and had received surgery thank God. My head shape has gotten better significantly but it is still narrow and my forehead seems to be protruding outward. I thankfully have a full head of hair but am afraid of what will happen when I go bald. I just want to talk you more in depth and possibly send some pictures. As you can see from the pictures my head shape isn’t as bad but it is more of a cosmetic issue. My only concern is of complications that could ruin my appearance for the rest of my life or going bald from complications from the surgery. Hopefully you can get back to me asap I’m excited for your reply as I have found someone out there that can help!
A: Your picture does show the remnants of having originally had scaphocephaly or sagittal craniosynostosis. As you have mentioned the front to back distance of your skull is just a bit long with a slightly protruding forehead and a somewhat narrow skull width. I assume hidden within your hair is a scalp scar from the original infantile craniosynostosis surgery. The question now is whether any effort at improving your skull shape justifies the effort. I do think the forehead bulge can be reduced, certain skull areas smoothed out and some width added using your existing coronal scalp scar. This is not a skull reshaping procedure in my experience that is associated with any major complications, only minor aesthetic ones.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping surgery. When I was a baby I had torticollis and i’m pretty sure this is what caused my plagiocephaly. My head looks like it was pushed in on the right side. I think the torticollis made me sleep on my right side a lot when I was a baby and thats why the right side of my head is more flat than the left. Here are some pictures of when I shaved my head. As you can see I would need an implant on the right side just above the ear and on the left side on top of my head to make my skull symmetrical. The back of my head is ok. Could you tell me if this is possible? Also maybe this could be done under local anesthesia with sedation? One last thing, I still have a head of hair and I’m a bit worried that an implant would put pressure on the hair follicles and blood flow resulting in hair loss. Is this a possible risk?
A: Certainly skull reshaping can be done for augmenting these two areas. The only question is which implant material to use. It could be done using either intraoperatively applied bone cement or custom computer-designed implants for each area. Given the asymmetric nature of the skull problem and the various shapes of implants needed, I would prefer to use custom designed implants as the most assured method of obtaining the best skull shape result.
Placing a skull implant is not something that can be comfortably done under local anesthesia/sedation and would not save you any money even if it could. Because a major cost of surgery relates to the time spent in the operating room, local/sedation cases take longer to do than when under general anesthesia. So any cost savings obtained by leaving out the anesthesiologist’s fee is wiped out by the longer time spent in the operating room
Lastly, raising scalp flaps and placing implants has no adverse effect on hair survival or growth.
Dr. Barry Eppley
Q: Dr. Eppley, I am 42 years of age and have suffered all my life with what people around me have described as a square head. The head isn’t misshaped at the side or the back but is flat on top with a bit of a bump in the centre of the top. This has made all hair styles very difficult throughout my life and has affected me severely.
I wanted to know the following:
1) Is there any surgery available for this type of head shape?
2) How long would such surgery take and what kind of recovery is involved?
3) What are the results of such surgery?
4) What are the risks of this skull reshaping surgery?
5) Can you show images of what the likely results will look like before surgery?
A: Based on your description, it sounds like you need a convex augmentation across the top of your head for skull reshaping. In answer to your specific questions:
- Skull reshaping by onlay augmentation is a common surgery to buld up
- It is a 2 hour surgery under general anesthesia with about a week recovery at longest.
- The results of such surgeries are always successful in terms of improvement.
- Besides a fine line scalp incision needed to perform the surgery, the risks are generally aesthetic…shape and smoothness of the augmentation.
- I would need to see a front and side view pictures of your head to do predictive computer imaging.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping and brow bone reduction surgery. I know you probably get these comments a lot, but I have always been very self conscious about my head shape and eyes. First my head is I guess a triangle oval shape but from a straight view it makes my head look very square and the top of my head is sort of flat. I absolutely hate it, it bothers me everyday. I wake up because even when I wear hats my head still looks square. I want the top of my head to look more smooth and oval shaped like a normal head but my head just looks fat. Also on top of that my eyes are really really puffy and close set which bothers me a lot also. I hate the boney parts at the end of my eyebrows. I feel they make the close set eyes look worse and how the bottom of my eyes are so pockety. This is destroying my self confidence day by day. I need to know if there is anything possible I can do so I will be happy in the end and not disappointing nor satisfied with a procedure. I have attached a couple pics for you to see my troubles. I love my hair but this head shape hurts my self-image. Also when I have short haircut it is embarrassing to me.
A: Based on your description of your concerns, it appears that a skull reshaping procedure with augmentation and lateral brow bone reduction is what is needed for improvement. Because you head is flat across the top, it can be built up between the two temporal lines to more of an oval shape by applying a bone cement material. There is a limit as to how thick it can be based on the scalp stretches but I would imagine that about 1 cm thickness in the very middle can be added. The tail of your brow bones (boney parts at the ends of the eyebrows) can also be reduced. All of this can be done through either a scalp incision or a smaller scalp incision combined wth upper eyelid incisions.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping surgery. My head shape is not normal. It is flat from the back side and inclined backward at the forehead making it smaller on the top as a whole. My face is not much wider as well resulting in a small head. I want to increase head size especially from my back side and forehead areas. Please tell me which procedure I need whether it is an implant or bone cement filling.
A: When it comes to skull reshaping and the aesthetics of your skull, you are talking about a sagittal (front to back) deficiency. Your forehead is slanted backward (retroclined) and the back of the head is flat. (or has a reverse retroclination compared to the front. This is treated by two different methods of dual forehead and occipital augmentation. It can be done with either a bone cement filling material (usually takes 150 grams) or custom forehead and occipital implants made from 3D CT scan. There are advantages and disadvantages of either approach but the end results of either one are the same with a potentially dramatic difference in the volume of your skull from front to back.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull augmentation I was wondering if you ever use an inflatable under the crown of skull to inflate skin so you can have more room to shape head? My niece needed an inflatable on her leg when she was young, which they used when they removed cancerous skin. I believe they can do this if area on skull needs extra skin to cover cement. If you do this, maybe you can tell he how much and my procedure can be a two step procedure. If I can pay for this and come back when time for procedure to correct and reshape flat areas. Please let me know. Not sure what the procedures are called but I may need more serious fix and may need more room for reshaping.
A: When it comes to skull reshaping or skull augmentation, you are referring to a two-stage approach initially using a tissue expander. For larger amounts of skull augmentation, particularly for a flat back of the head, more scalp is needed. A small scalp tissue expander, slowly inflated over six weeks, creates more than enough extra scalp tissue to cover any degree of augmentation desired.
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’m very interested in pursuing skull reshaping surgery to fix a congenital defect involving the right side of my skull. For as long as I can remember, it has been both a cosmetic concern and one of comfort. (causing pain/discomfort with prolonged lying on the right side or with wearing helmets of any sort). From reading your web-based article, I believe I may be a good candidate for your procedure. I’ve attached a few photos of the affected area for your review; of course it’s difficult to capture the magnitude and dimensions of the defect (a bulging, sharply angulated defect) with mere photos. I thank you in advance for your time and consideration.
A: As best I can tell from your pictures, the location you are referring to is the right parietal/posterior temporal region. You describe it as a congenital defect but also call it bulging. I suspect you mean a lifelong bulge in this area which is painful. This is very consistent in my experience with more of a temporalis muscle problem in that area. Most patients and even physicians have little appreciation of how thick the temporalis muscle is in that area and how far back it goes. It always feels like bone but there is a 5 to 7mm layer of muscle under exactly where you point. Having done a far number of temporalis muscle reductions/resections (temporal reduction) in this area for symptoms described just like yours, I can attest that your concerns are more likely muscular based than being a bone problem. A CT or MRI will show how thick the muscle is in this area. However, I often make the decision to do muscle resection/reduction based on the description and physical examination only.
Dr. Barry Eppley
Q: Dr. Eppley, I’m currently struggling with a flat back of the head and a small head too. Can skull reshaping surgery be done on me to add any implant to mainly the back and top parts of my skull that would give me a decent sized head that is also well rounded ? How effective is this surgical procedure and what are the possible negative effects of any implant on my actual skull?
A: Skull reshaping (augmenting a flat area) can be done to almost any part of the skull and its limits are based on how much the scalp can stretch to accommodate the volume of augmentation. Based on what one’s expectations are, it can be a highly effective procedure. I would have to see some pictures of your head that show the flatness and then do some computer imaging to see if what skull augmentation can do is sufficient. It is always important before surgery to find out if the changes meet a patient’s expectations and to determine how much volume is needed to create that augmented effect.
There are no known long-term effects of the materials used in skull augmentation as it relates to the bone or the overlying scalp tissues. Bone resorption is not known to occur nor is scalp thinning over it.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a minor skull reshaping procedure. Can you fix the dent on the right side of my head with relatively minimal invasive surgery? Question 2: I have had the dent as long as I can remember, I’m 42 years young! Is there a formal name for my “condition”? I suspect what we are looking at here is in fact a dent. My only other theory is that my forehead maybe high on my right side thus giving the appearance of a dent toward the back right side? Thank you very much for your time.
A: You at an ideal candidate for a small skull reshaping operation. You do, in fact, have a high forehead dent or groove in the bone. It has no other formal name although it lies parallel or may be over the original coronal skull suture. Thus it may be a malformation of the coronal suture where the two edges of bone come together to fuse. Regardless of its etiology, it can be treated by a minimally invasive cranioplasty procedure. By making a very small scalp incision (less than 1 cm.) the tissues over and around the dent can be elevated. Then through a small tube, a bone cement material can be injected and then smoothed out from the outside as it sets. This could be done under local/IV sedation with really no recovery other than a small amount of swelling. The ‘trick’ to this procedure is to not overfill it and get the entire area smooth and flat. You don’t want to trade off a ridge for a dent.
Dr. Barry Eppley
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
Q: Dr. Eppley, I am interested in skull reshaping surgery for the back of my head. I have attached some pictures. Although they are a little fuzzy I think you can see the problem. The left is much flatter than the right. Let me know if it is possible to do what I want which is to fix the head shape so that it is more round and therefore more normal in the back on both sides (more on the left than the right.) I also have a few more questions to ask. First of all, are there any long term side effects of the surgery? (not the rare ones but common ones I should know about as I know there are risks with any surgery). Secondly will I need to keep coming back for surgeries in the future (for such things as touch-ups)? Will it affect my hair growth? These are questions I was unable to find out for myself. I hope I have not been too much much of a bother. I am really excited for this as you can see and I really, really appreciate your prompt and helpful responses. Thank you for everything.
A: As skull reshaping surgery goes, your back of the head problem is the most common skull problem that I treat. Flat back of the heads are common and rarely are they perfectly symmetrical. They are corrected by an onlay cranioplasty procedure, most commonly using PMMA as the augmentation material. The surgery is done through a limited 9 to 10 cm incision (no hair is shaved) placed closer to the back of the head through the material is applied and shaped. The only short-term complication (< 6 months) that I have ever seen is aesthetic in nature, how smooth is the applied material and does it give enough of the desired augmentation. If either is observed and bothersome, a touch up procedure may be done to smooth it out or add more material if possible. I have not seen any long-term complications. If one has a satisfactory result by three months after surgery to their own assessment, then no further procedure will ever be needed. Lastly, he procedure does not affect hair growth.
Dr. Barry Eppley