What Is The Best Craniplasty Method To Fix My Forehead and Temple Defects From A Prior Craniotomy?

Q: Dr. Eppley, Firstly, I would like to take the opportunity to thank you endlessly for the abundance of information you have on your website regarding cranioplasty. You seem to be the only person that has posted information about it, which has in turn reassured

me throughout my own medical process.
The reason for my email is to find out the best proposed solution you can present to me for my current cosmetic concern.
I have noted in some of the answers you have provided prospective patients with, you recommend using Kryptonite Bone Cement. My enquiries all relate to the use of Kryptonite Bone Cement to amend some defects I have from a past cranioplasty. I would really like to avoid having to shave off my hair where possible as it is almost as devastating as the defects themselves.
Last year in June 2012 I had a titanium plate inserted to cover the bifrontal (top front part of my head) due to replacing bone from a decompressive craniotomy after sustaining Traumatic Brain Injury. After the swelling had subsided from the insertion of the plate, I have been left with a visible line (indentation) where my plate goes across my forehead. I have also been left with a decent sized dent in the side of my face in the temple area, there also seems to be a smaller dent on the other side too. I have attached photographs so you can see the extent of my concerns.
What I would like to know is:
1. Will Kryptonite Bone Cement be suitable to use with my titanium plate? It seems to be an ideal solution to conceal the indentation along my forehead (where the plate meets my forehead) and fill in the gaps around my temple area and being injectable reduced the shaving and scarring as I would imagine.
2. If Kryptonite is not suitable, please tell me what the other options are that you would suggest.
3. Are there any side effects that I would need to be aware of?
4. Are there any long term studies on Kryptonite or proposed solutions that are available?
Many thanks in advance for your assistance, I eagerly anticipate your response.

A: In looking at your pictures and the accompanying commentary, let me answer your questions in the order that you presented them.

1)      Kryptonite bone cement is no longer commercially available for reasons that are unknown to us as surgeons. But even if it were, it would not be appropriate for your case. Any injectable cranioplasty technique requires an unscarred scalp/skull area, no indwelling hardware and a defect surface area that is not unduly large. With your craniotomy history, presumably large titanium plate and the extent of the cosmetic deformity (bitemporal crossing the forehead), it is going to require an open cranioplasty approach to adequately correct. It should be approached no other way. While this is not the approach you would like to hear, the good news is that the procedure can be done without shaving any hair. I never shave any hair for an extracranial crcanioplasty procedure.

2)      The only issue with an open cranioplasty is what material to use. It could be either hydroxyapatite (HA) or standard acrylic cranioplasty. (PMMA) There are some minor advantages and disadvantages with either material. I would have to see some x-rays of the extent of the plate location to answer that questions better.

3)      The only real risks of this procedure are aesthetic in nature. Can a seamless transition be done in building up all the areas from the temples across the forehead. The front of head looks very much like a ‘vice’ across it so more volume is needed to build out these areas in your cranioplasty than one would think.

4)      There are no long-term studies of Kryptonite that have ever been published. But this is irrevelant now since it is no longer available for clinical use.

Dr. Barry Eppley