Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Case Study – 2nd Stage Custom Skull Implant for Crown Augmentation


Background: Deficiencies of the crown area of the head are unique to females. They often compensate for such skull height deficiencies through hair style camouflage techniques. Two definitive treatment is a custom skull implant made from a 3D CT scan.  While not being able to add unlimited increases in skull height due to the limitations of the stretch of the scalp, they do provide the most effective skull augmentation method know today.

When women consider implant augmentation of the crown and surrounding skull areas, the question is always how much additional height/fullness can be obtained.While every patient’s scalp is different, as a general rule a one-stage skull implant will probably create 50% to 75% of the result many women really want. Much more of a result or even their dream result often requires a two-state approach to achieve. (first stage scalp pander and second stage implant)

But for a variety of reasons, some women may have to opt for a one-stage skull implant even though they know that their skull augmentation result will not be ideal. But this does not mean further augmentation may not be possible later.

Case Study: This middle-aged female had a custom skull implant placed one year earlier for crown augmentation. Her initial implant had 9mms of central projection over the crown. She now desired for augmentation and a new implant was made that doubled the central projection to 18mms.

Under general anesthesia her original scalp incision, which had healed beautifully, was reopened and the implant exposed. The capsular tissue could be seen to e adherent to all of the original perfusion holes which has been placed through it. The implant was separated from these scar bands and removed. It was replaced with the new casual implant whose height increase could be fully appreciated when laid side by side. The scalp closure was tight but secure over it.

Patients can be initially content with their skull augmentation result but grow desirous of more as they accommodate to the change. Or that may chosen the one-stage approach for practical reasons, hoping it will be enough but are that it might not be. Either way, an indwelling  skull implant does act as a tissue expander for which s larger implant can be successfully placed later.


1) For additional crown of the skull augmentation effect, a second custom skull implant can be placed after the first one.

2) An indwelling skull implant acts as a tissue expander, allowing for a second large implant to be placed that would not have fit the first time.

3) Doubling the central area of projection can usually be safely achieved in the second custom skull implant.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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