What Type Of Skull Reshaping Procedure Do I Need For My Head Shape?

Q: Dr. Eppley, Hope all is well. Attached is a zip file of some new photos for the upcoming appointment. I’ve also added the DICOM file that came with my CT scan cd. If you’re unable to view the CT photos or would prefer this sent a different way please let me know.

Also, just a quick description of what I’m considering (in order of priority):

1) Removal of some height from sagittal region. There is also a ‘bump’ at the front. Looking at posts online it could be similar to (https://exploreplasticsurgery.com/case-study-anterior-sagittal-ridge-skull-reduction/?doing_wp_cron=1647296504.2379939556121826171875

4) Plastic Surgery Case Study – Anterior Sagittal Ridge Skull Reduction – Explore Plastic Surgery
The anterior sagittal ridge skull deformity can be reduced by a bone burring technique.
exploreplasticsurgery.com

5) Overall the height removal would not be significant but the ridge seems to extend nearly the full length (front to back). My concerns would be surgery of that volume and scarring/placement. Additionally, I have a metopic ridge and I’m not sure if that’s a factor to consider.

6) I’m still hesitant on the thought of implants but I’m not sure if height removal would be enough and may actually make things look ‘weirder’ if some width isn’t added as well. I have a fairly thin head and I’m worried about the possibility of an implant ‘sticking out’ or not transitioning with the skull due to the amount of space available. The right side would be the priority but if the left/back is feasible I would consider it. In the zip file is an example photo, turning off the layer gives an idea of what I’d be looking for.

7) There’s a slight dip in the back that can be seen best in the third top photo (left side). This is not a huge priority but if it’s feasible with the above then I would consider.

My main concerns are scarring (location, size, healing), final appearance, whether a scalp expander is needed, if it would take numerous surgeries to accomplish, and available options if an issue occurred (i.e. implant crack). I plan to go over this during the meeting but since it’s only 30 minutes I figured a general summary may be helpful.

Thank you,

A: Thank you for sending all of your skull reshaping information to which I can say the following:

1) Your pictures show the classic aesthetic skull shape deformity which is a combination of an excess and deficiency in which there is a sagittal ridge (minor) with more significant parasagittal-parietal (upper back of the head) deficiency. Understanding this aesthetic head shape problem will allow one to have great insight into what the effects of any correction will be.

2) You have correctly assumed that any sagittal ridge reduction will have a very modest effect

3) More significant head shape changes come from either a combination of sagittal ridge reduction and parasagittal-parietal augmentation or parasagittal-parietal augmentation alone.

4) When you look at the options as detailed in #3 what becomes apparent is that you can’t have everything you want exactly the way you want it. Less surgery without an implant produces modest head shape changes. More surgery with an implant makes a much better head shape change but requires an implant to do so. Like in any other aesthetic surgery where an ideal option does not exist and it comes down to a compromise…it is all about what how much effort does one want to put into it for what type of change. It is my task to educate you as to what those changes would potentially look like as this requires computer imaging. (that will not be done until next week)

5) In the interim a diagrammatic change for both procedures is attached. The incision location for both is the same.

6) A 3D CT skull scan provides the information necessary to perform the procedures but it does not tell which procedures are the best aesthetic choice for you. That is the role of preoperative computer imaging.

7) DICOM CT scan data without a viewer program to see it in 3D is not useful.

Dr. Barry Eppley

Indianapolis, Indiana