What Is The Risk of Developing Scalp Keloids from Custom Skull Implants If I Have Keloid Scars On My Body?

Q: Dr. Eppley, I was curious generally speaking what percentage of people have the type of skull shape which would accommodate a 1 inch implant for cosmetic stature gain in an aesthetically pleasing manner, and what that ideal skull shape is. 

To be candid I was surprised to find that this is even done, because my first instinct was to assume that such an implant would look unnatural, like something from Star Trek or Coneheads or something. Is it the case that average skull height is variable enough throughout the population that such a change is easily concealable? Does the size of one’s forehead or their hair type or any other factors significantly affect one’s suitability for the height increasing procedure with respect to concealment? 

I feel like there are two bifurcated philosophical schools when it comes to cosmetic surgery patients – those who don’t mind a slightly (or significantly) unnatural look, which perhaps represents the vanguard of cosmetic augmentation, and those who want as close to a natural appearance as humanly possible. I would definitely place myself in the latter group and wouldn’t want anyone to wonder “what’s up with your head”? 

I was also curious what your opinion is regarding surgery on the scalp for patients with a history of keloids developing in common keloid forming areas. For example I have several keloids in my sternum area as well as my right shoulder, which apparently are two common areas, however I thankfully do not have any on my face. Could a small “test incision” be done on the scalp to make sure the area responds to trauma well before an actual procedure? 

Thank you for reading

A: Thank you for your inquiry. The key to all skull implants is that their design has to look like they belong there as a natural extension of the convex shape of the skull.  As a result they cover a much larger surface area than one would initially think to do so. And usually most patient’s way over estimate the thickness of the augmentation they need because they focus on a simple linear measurement rather than the volumetric effect of large surface area coverage. The limiting factor in any skull augmentation is the ability of the scalp to stretch to accommodate what is placed underneath it. In general most people can tolerate a 100 to 150cc implant without a first stage scalp expansion.

When it comes to what patients want, very few patients want anything but a natural looking result. One’s interpretation of what looks natural will vary as what one person deems natural may be unnatural to another. But in skull augmentation everyone wants a natural head shape result.

Trying to correlate how a scar looks on the body to what may occur on the face or scalp is not comparable. Most likely you have hypertrophic scars, not true keloids, which are common in many people particularly in the sternum (which is a terrible area for a scar) as well as the shoulder which is a high motion area with thick reactive skin. Making a test incision in the scalp is not replicative of the situation when an implant is placed underneath it with the incision subsequently closed under tension.

Dr. Barry Eppley

Indianapolis, Indiana