What Plastic Surgery Procedures Can Be Done For Plagiocephaly In A Teenager For His Skull And Face Asymmetries?

Q: My son has torticollis which has contributed to his skull and facial plagiocephaly. We did not know about the cranial helmet when he was young and his condition was left untreated. He is now a teenager and very self conscious about his head being flat on one side and his face being skewed. He asked if there were any surgeries or anything we can do to correct it. I found your website and was amazed that you have experience with his exact condition. What can be done for him at this point?

A: Deformational plagiocephaly causes a very predictable pattern of skull and facial changes when untreated as an infant. As the craniofacial bones rotate around an axis, the pattern of asymmetries become flatness on one side of the back of the head and a protruding forehead, brow bone, cheek and jawline on the same side on the front. This can create very visible facial and front (forehead) and back (occipital) skull changes. I have seen a wide range of facial plagiocephaly problems in the degree of expression of the amount of asymmetrical differences.

Since the fundamental problem can not be reversed, changes must be done in an effort to camouflage or improve the different asymmetries. These can include an occipital cranioplasty to build up the flat area on the back of the head and numerous facial structural changes. The face can be altered by forehead and brow bone reshaping, cheek augmentation and jaw angle , and a chin osteotomy, all done with the objective of improving facial symmetry. The combination of skull and facial procedures that are helpful will be different for each patient. It requires an individualized assessment and computer imaging to determine the best plastic surgery plan for each patient.

Dr. Barry Eppley

Indianapolis, Indiana