Will Fat Grafting Work For Skull Augmentation?

Q: Dr. Eppley,  I am still thinking about trying to get some volume to the back of my head using fat grafting.

It sounds quite promising that it could work for smaller changes even though it is not safe to say how it will stay on long term.

However, I think I have enough fat available for harvest.

Since you also used fat for some of your patients to achieve more volume in some areas of the head/neck – would you say that there are good chances I could achieve a volumce increase like shown in the attached picture?

I have also heard of the possibilty to prepare the fascia of the skin and double it in the area where some more volume is needed to create a rounder head shape. Have you heard of this technique and could you please give me your professional feedback on a combination of this and fat grafting for a (longterm) volume increase?

Your opinion is highly appreciated. Thank you very much for your education and sharing the knowledge and experience.

A: There are several fundamental concepts about injection fat grafting that are universal no mattrer where the fat is injected. First and foremost it is a gamble, no one can tell you with any scientific precision how much fat will or will not survive.  It could be 0% to 100%. It is a metabolically active tissue in which there are dozens of factors that affect its transplantation survival. But what is known is that it survives best in tissues that have some fat natuirally present and in tissues that are not overlying tight. (two factors which don’t bode well for the scalp recipient site) Thus you undergo fat grafting under two specifics circumstances…..when no other procedure is available for the desired effect or whether the alternatives are so unappealing that you want to try something ‘simpler’ first. Second, any fat that survives is metabically response to numerous influence like that of fat anywhere in the body. Thus its long term volume retention is suspect…whether that means it can get bigger, smaller or remain the same is unknown.

Dr. Barry Eppley

World-Renowned Plastic Surgeon