Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Case Study – Female Crown of the Skull Augmentation with a Custom Implant`


Background: The shape of the head in a female has important aesthetic significance. While the concept of having a ‘nice round head’ is perceived as an ideal head shape, the ideal woman’s head shape is much more of an oblong shape. But the area over the crown of the head is of particular significance as it should be the highest peak of the skull in women. This is quite unlike men who would view such a location of maximal skull height as an unaesthetic protrusion.

Why women like a more prominent crown of the head is not precisely clear. At the least they do not like a crown area that is flatter or lacks projection. It may be its appeal from is influence on how it pushes the hair upward. This is suggested because many women who undergo crown augmentation talk of the tedious nature of teasing their hair to look like they have a higher crown area of the head.

Creating a higher crown of the head can only be done by building up the skull. Between bone cements and implants, these are the only two effective augmentation options. While fat grafting has become popular for injectable soft tissue augmentation, this technique will not work for skull augmentation as the scalp is too tight to be pushed outward by the soft consistency of fat. Custom made implants from the patient’s 3D CT scan has become the most effective technique to ensure the best augmentation shape and the desired area of skull coverage.

Case Study: This young female was bothered by the flat area over the crown of her head. A 3D CT scan showed how her skull shape sloped downward over the crown area as well as a triangular shape from the front view.

From the 3D CT scan a custom implant was designed to cover the crown area and give a more convex shape. The maximum central projection was set at14mms which was felt to be as much as the scalp could stretch in a one-stage implant augmentation.

Under general anesthesia and in the prone position, a 9 cm horizontal zigzag scalp incision was made over the nuchal ridge of the occiput. A subperiosteal pocket was made way up over the crown area. To keep the incision as limited as possible it is necessary to fold the implant for insertion. In thicker skull implants that are 1cm or over in the area of maximal projection, it is helpful to create a tighter implant roll to remove strips of material on its inner surface parallel to the direction of the implant roll.

The implant is then inserted in a rolled fashion and unrolled and positioned once inside the pocket. The compass marker on the implant serves as a key guide for proper implant positioning and midline alignment as this is the only part of the implant seen through the incision.

A custom skull implant is the most assured method for a higher crown area for women, creating the so called ‘bumpit’ effect. The firm composition of the implant provides the best push on the overlying scalp creating a permanent long-term augmentation effect.


1) The flat back or crown of the head is the common location for aesthetic skull augmentation.

2) The maximum thickness of the implant’s central projection and the amount of skull augmentation possible is controlled by how much the scalp can stretch to accommodate it.

3) Custom skull implants provide a ‘bump it’ effect for females.

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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