What Are The Specific Details Of Having A Cosmetic Occipital Cranioplasty?

Q:  Dear Dr. Eppley, I have done a lot of reading on your website and interested in the cranioplasty procedure to fix the flat spot on the back of my head  (on the top area on the back).  I am a female and have noticed this since my teens and always thought there was no help until I came upon your website, now I am hopeful.  I am scared and nervous about this procedure and have several questions:

1)  Is this a new procedure because I don’t see where this has been performed for purely cosmetic purposes before by other doctors?

2)  Would you say the injectable approach doesn’t achieve as much as an effect as the open incision approach?

3)  Also, in the open incision approach, I know you use either PMMA or HA materials.  If the PMMA is used, does that mean you will need to use screws to attach the material?  Is it riskier than using HA since screws are used?

4)  When did you first start performing this procedure and approx how many have you done? 

5)  Have there been any complications with any of them?  If so, what were the complications and how did you fix them?

6)  I live in Houston, TX and would be traveling alone.  From what I read, this is an outpatient procedure, therefore I am concerned about being without care the first night after surgery.  Would you recommend that I get this done in the hospital as inpatient, so I am under care?  

7)  Also, how do you determine how much material to add? 

8)  Do you place expanders to stretch out the skin if I want more material added to achieve my desired result?   

9)  Will there be a noticeable difference afterwards? 

10) Do you take any sort of imaging to determine the shape you plan to mold?

11) Will you ‘sketch’ out the final shape beforehand so I know what results to expect?

12) How many visits will this procedure require?  Including pre-op and post op/follow-up visits? 

13) What is the recovery?  How many nights will I need to spend in IN? When am I ok to fly back home? When can I go back to work? 

A: In answer to our detailed questions:

1)      Although this is a relatively ‘new’ procedure from a cosmetic standpoint, it is based on the decades old principle of reconstructive cranioplasty from craniofacial plastic surgery. The only thing that is really new about it has been the development of some new cranioplasty materials to use.

2)      The injectable approach can achieve just as much as an open approach. It is about volume of material used and its costs that partially controls the result achieved.

3)      There is no increased risk of screw fixation for a PMMA cranioplasty technique.

4)      I have done cranioplasties for nearly twenty years. In the past three years, I have developed some techniques for cosmetic skull augmentation.

5)      The main complication with an injectable approach is getting a smooth contour to the material. I have had one wound healing complication from an open PMMA cranioplasty when using an old hair transplant scar for access.

6)      Having an occipital cranioplasty as an outpatient is just fine. Patients report virtually no pain afterwards.

7)      One of the key issues is how much material to use. That will be determined by the approach used and what the scalp tissues can tolerate. My experience has shown that open cranioplasties through small incision use about 30 to 40 grams with either PMMA or HA. Injectable kryptonite usually uses 25 grams for the occipital region.

8)      While the use of tissue expanders does allow for more material to be placed, it has not been necessary in my experience. This would also make the procedure an unappealing two-step process.

9)      There will be a noticeable appearance afterwards. It is a question of how much.

10)   No imaging is required. It is an artistic molding based on the extent of the defect and the patient’s after surgery shape desires.

11)  Computer imaging can be helpful in understanding what to expect.

12)  There are no after surgery visits required for an occipital cranioplasty. A good presurgical consultation can be done by phone or Skype video in addition to seeing patient pictures. Patients come in the day before surgery for a formal consultation.

13)  Most patients return home the very next day and return to work in just a few days after

Dr. Barry Eppley

Indianapolis, Indiana