Will Injectable Fat Grafting Work For Skull Augmentation?

Q: Dr. Eppley,The problem that plagues me is the shape of my head. I have a small head, behind it is flat and above and narrow and has indentations, irregularities. A surgeon promised me the transfer of fat. He told me that the insertion of prostheses is a risky, very, very expensive operation that leaves scars on the scalp. I am unsure about the method because I know that the fat is reabsorbed and therefore I should intervene again. Are there other materials that can be used that do not leave scars and are long lasting ? I do not know what to do. This malformation has conditioned my whole life. What do you recommend? Is there is a solution for my case. Pending your reply, I offer you my best regards.

A: Thank you for your inquiry and detailing your head shape concerns. In essence you are asking for skull augmentation of unknown amounts. (at least to me at this point) While injectable fat grafting can be a very useful technique in the face, it has a very poor outcome in the scalp/skull for a variety of reasons. But most importantly it can never provide an adequate push on the tight overlying scalp tissue to create a substantial head shape change. While there would be no harm in doing a fat injection operation it is simply not going to work for a visible head shape improvement. But I can fully understand why almost any plastic surgeon would offer a fat injection solution because that is all they know how to do. But I have yet (short of the forehead) ever seen a successful skull augmentation result with fat grafting. It is also common that plastic surgeons, who have never seen or done aesthetic skull augmentation surgery, would make comments about the operation that are inaccurate. (if they have no first hand experience they would serve the patient better by simply stating they have no knowledge about that type of surgery)

Effective skull augmentation requires the placement of a custom designed skull implant made from the patient’s 3D CT scan. These are typically inserted through relatively small scalp incisions. Whether this wold be effective for your aesthetic head shape change would require doing some computer imaging of pictures of your head to determine what type and magnitude of change you are seeking.

Dr. Barry Eppley

Indianapolis, Indiana