Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

OR Snapshots – Large Custom Skull Implant


large-custom-skull-implant-intraop-dr-barry-eppley-indianapolisSkull augmentation is an essential procedure in aesthetic skull reshaping surgery. While onlay cranioplasty (aka skull augmentation) can be done by using a variety of synthetic materials, larger expansions of the skull’s outer surface are most reliably done using 3D custom implant designs. Using the patient’s 3D CT scan, a custom skull implant can be designed to cover a large surface area of the skull. When placed over the patient’s head prior to insertion it can be seen to be impressive in size.

The implant is placed through a scalp incision as small as possible. Even such a large skull implant can be placed through an incision smaller than its width due to the implant’s flexibility.

How large a skull augmentation that can be accomplished is determined by the ability of the scalp to stretch. After the incision and undermining the scalp can stretch to cover an implant to varying degrees. Each person’s scalp has different amounts of elasticities which is partially related to how thick it is. The thicker the scalp the more it is capable of stretching in my experience. There is an unknown balance in each patient between how much their scalp can stretch vs how large can the skull implant be. This is carefully evaluated and thought through during the custom skull implant design process.

When it is believed that the amount of skull augmentation desired exceeds the ability of the scalp to stretch to accommodate it, a first stage scalp tissue expansion is needed.  A small inflatable device is initially placed and expanded by percutaneous saline injections until the scalp has developed additional stretch. This is usually done six to eight weeks prior to the placement of the custom skull implant. This is needed in less than 10% of skull augmentations in my experience.

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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