Which Is Better For Skull Augmentations…Implants or Bone Cements?

Q: Dr. Eppley,I am interested in skull and face reshaping surgery.  I’m not happy with my head being too wide and having a bump on my left side.  My head is also flat at the back.  Thus, I am interested in having temporal muscle reduction surgery ( bilateral ) and augmentation of the back of my head with hydroxyapatite.  I would also like more masculine and prominent forehead bone and would like to have augmentation with hydroxyapatite there as well.  I have read that Dr.  Eppley recommends implants in many cases, but I’m more interested in hydroxyapatite. However, it would be good to know the difference in price between implants and hydroxyapatite in my case? 

A:I will not use hydroxyapatite  cement (HAC) for any form of significant skull augmentation…and augmenting the back of the head and the forehead-brow bone qualifies as significant skull augmentations. HAC is a terrible way to try and do skull augmentation. The incisions needed to use it properly are big, it is very expensive, the amount of augmentation is very limited and there is poor control of its shape. The biologic appeal of HAC is great but its clinical application for onlay augmentation is poor. It was never made for skull augmentation, it was made to fill skull defects which is a very different geometric problem. Implants may be implants but their aesthetic results are so superior and the ability to place them through small scalp incisions makes their lack of biologic appeal an acceptable tradeoff.

Dr. Barry Eppley

World-Renowned Plastic Surgeon