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Posts Tagged ‘sagittal ridge skull reduction’

Case Study – Sagittal Ridge Skull Reduction

Thursday, May 19th, 2016


Background: Perhaps to the surprise of many, men make up a significant percent of aesthetic skull reshaping patients. This is due to the show of the skull shape that occurs with shaved heads, closely cropped hairstyles and thinning hair cover. Men become exquisitely aware of any prominent bony areas or indentations or deficiencies.

One of these aesthetic skull shape issues is that of the prominent sagittal ridge. This midline raised ridge, which occurs mainly along its posterior aspect, is easily seen as the highest part of the skull. The ridge creates a peaked or more triangular shape to the top of the head rather than that of more of a convex shape.

Sagittal skull ridge reduction is done by a burring technique. While this technique is very straightforward, its effects are limited by two factors. The bone can not be reduced by than just into the diploic space. Once the diploic space is entered significant bleeding occurs and this can lead to fluid collections that develop under the scalp after surgery. Because of the visibility of the scalp on the top of the head, the incision used to access the sagittal ridge must be limited. This can influence the extent that the sagittal ridge can be reduced.

Case Study: This 35 year-old male presented with a prominent sagittal ridge closer to the crown of the head. On the most posterior aspect of the sagittal ridge there was an indentation or dip between two areas of the raised sagittal ridge.

Sagittal Ridge Skull Reshaping plan Dr Barry Eppley IndianapolisUnder general anesthesia, a curved scalp incision of 7cms was made perpendicular to the sagittal ridge on its back third. Through this incision the sagittal ridge was reduced by 5ms along its length. At the area of the dip, 2ccs of hydroxyapatite bone cement was applied to raise it up to the surrounding skull contour.

Sagittal Ridge Skull Reshaping result front view Dr Barry Eppley IndianapolisSagittal Ridge Skull Reshaping result side view Dr Barry Eppley IndianapolisA head dressing and drain was removed the following day. The change was immediately seen in the skull contour with a successful sagittal ridge skull reduction.


1) The prominent sagittal ridge is an almost exclusive male skull shape concern.

2) The limits of the sagittal skull ridge reduction is the thickness of the bone and the length of the incision permitted by the patient.

3) Sagittal skull ridge reductions can usually be reduced from 5mm to 7mms.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Anterior Sagittal Ridge Skull Reduction

Saturday, February 6th, 2016


Background: The shape of the skull is seen as most aesthetic when it has a curved shape across the top from the front view. This curved shape can be altered by a variety of congenital deformities. One of the most common is an alteration of the midline sagittal suture. When complete premature sagittal suture closure occurs, the entire skull shape becomes very elongated and very narrow. (scaphocephaly or premature sagittal suture craniosynostosis) But more commonly partial or minor variations of sagittal craniosynostosis occur.

With incomplete or minor variations of premature sagittal craniosynostosis occur, a prominent sagittal ridge may develop. It is not significant enough to cause an overall alteration of skull shape, but does present as a visible raised midline bony ridge. It can occur anywhere along the original sagittal suture location.

The sagittal ridge skull deformity has become more of an aesthetic head shape issue for men due to either hair loss or a shaved hairstyle. What once was not noticed or not of an aesthetic concern becomes apparent or a prominent issue when the shape of the skull becomes apparent with loss of hair coverage.

Case Study: This 30 year-old male was bothered by a prominent midline ridge on the front of his head. From the widow’s peak of his hairline back along the midline of the skull for 12 cms,  the raised ridge created a triangular shaped head from the front view.

anterior sagittal skull reduction markings dr barry eppley indianapolisUnder general anesthesia and through a small curved (5 cm) scalp incision, a handpiece and burr was used to smooth down the prominent bony ridge. The midlien ridge was reduced down to the diploic space of the bone, about 5mm to 6mms. The scalp incision was closed in layers with dissolveable sutures after a drain as placed. The drain was removed the following day after putting out about 30cc of blood.

Anterior Sagittal Ridge Skull Reduction result immediate Dr Barry Eppley IndianapolisHis postoperative swelling was moderate and this is how he looked within one day after surgery. The reduction in the midline ridge was immediately evident. He could walk around and really did not look particularly swollen or ‘surgical’ in appearance.

Reduction of the anterior sagittal ridge skull deformity can be effectively done by a bone burring technique. The key is to perform it through the smallest scalp incision possible. Special instruments and a handpiece and burr are used to remove the raised bony ridge as low as possible, blending it into the surrounding skull bone.


1) A sagittal ridge skull deformity consists of a midline raised ridge of bone anywhere from the forehead to the back of the head.

2) An anterior sagittal ridge starts at the old anterior fontanelle  and extends back along the skull for a short distance.

3) A bone burring technique can be effective at reducing the height of the sagittal rudge skull deformity.

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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