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Technical Strategies – Six Pack Etching in Custom Skull Implants

Custom skull implants provide a reliable and safe method for augmenting flat or deficient areas of the head. Like all face and body implants that are placed for aesthetic purposes, the surgery is fundamentally about placing a performed implant into the desired tissue pocket through the smallest incision as possible that will permit it. This is important because a scar is an aesthetic tradeoff and one that should not be overly noticeable and detracts from the augmentative effect of the implant.

To allow this implant principle to be effective, it requires a feature of the implant that is important…the implant must be deformable to pass through an incision that is smaller in diameter than the implant. This is easy to understand in a silicone breast implant, for example, and is the exact reason why the funnel insertion device was made to insert them through a very small skin incision. But it is a feature of a skull implant that is also needed to place it through a scalp incision. While a long coronal scalp incision can be used to place a skull implant, and the implant would not have to be deformable, few patients however want this scar burden for an elective aesthetic skull reshaping procedure.

Custom skull implants have a unique feature that is not shared by any other implants in the body. Their surface area coverage compared to the size of the body part in which it is placed is comparatively large. Thus it must be fairly deformable. While a solid silicone skull implant can be bent fairly easily, this bending must be in the form of a tight roll. The thickness of the implant determines how tight this insertion roll can be. To help make the roll even tighter and smaller in cross-sectional diameter is to cut wedges out of its internal surface. I call this a Six Pack Etching technique, borrowing the name from a liposuction method used on the abdomen to create visible inscription lines.

The six pack etching technique removes material from the internal surface of the implant which allows it to be rolled more easily for insertion through a small scalp incision.

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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