What Is The Best Method To Reduce The Ridge On The Top Of My Head?

Q: Dr. Eppley, How can I reduce this ridge in the top of my head? Do I need sagittal crest reduction. I have attached my skull CT scan for you to review.

A:I have reviewed your CT scan which has been enormously in determining both the origin of your sagittal crest, its thickness and surgical possibilities for its reduction/improvement. In looking at your head shape and the scan your proper diagnosis is a PSEUDO SAGITTAL CREST which means it llooks like a sagittal crest but it not a true sagittal crest. This means it appears because the skull around it is lower/deficient which makes it just look like there is a sagittal crest but there really isn’t. This is evident by the following:

1) A true sagittal crest is when the bone is thicker than the surrounding skull bone. not thinner. Your scan shows that the crest is thinner than the surrounding, which beyond making the proper diagnosis also indicates a full reduction of it is not possible/safe. (see attached imaging) This does nort mean some reduction is not possible just that a complete reduction can not be done.

2) Technically it is the surrounding skull (parasagittal-parietal skull) that is deficient or too low and building up the bone around the crest creates the better head shape result and fully eliminates the crest appearance. (see attached imaging)

3) In short what we have learned from the scan is that the sagittal crest can be directly reduced but its appearance can not be fully eliminated. Full elimination is possible with an overall better head shape but requires a different procedure. (custom skull implant) The choice comes down to how much improvement does one want and with what amount of effort does one want to put into it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon