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There are many different types of aesthetic skull reshaping surgery ranging from minor deformities to major augmentations and reduction. The most minor form of skull reshaping is reduction of a bump or high spot. Often mistakenly call osteomas, skull bumps are usually developmental and have no history of trauma. While most commonly occurring in isolation, multiple ones can also occur concurrently. They are far more common than osteomas of the skull.

What separates a skull osteoma from a skull bump is its shape. An osteoma occurs from a periosteal reaction to a bleed from a perforating blood vessel. As a result it has somewhat of a mushroom shape with a broader base of outer bone (the perceived bump) and an underlying smaller stalk of bone beneath it. This is what makes its removal by an osteotome effective as the smaller base of the osteoma can be easily separated from the normal skull bone.

In contrast a skull bump or spot protrusion has a broad base with no underlying stalk. It is a continuous outgrowth of bone that is confluent with the surrounding skull. As a result it can only be removed by high speed drilling of the entire raised bone. There is no chipping away at it with an osteotome as it is essentially a thickened area of outer table skull bone.

Regardless of either bony outcropping shape, they can be removed through very limited scalp incisions. With the exception of the non-hair bearing area of the forehead where indirect incisional access is used further back in the scalp, a direct overlying scalp incision is used. Such direct access is best because it allows for the smallest possible incisional length.

In skull bump reduction a high speed handpiece is used with a carbide burr. This allows reduction of the bone back down to a level of the surrounding skull outer table level. Should there be any bone bleeders with the reduction these are either cauterized or covered with bone wax.

Skull bumps could be removed under local anesthesia for the motivated patient. Often times it is done along with other procedures where the patient is under a general anesthetic already. No drains to dressing are usually used. One should expect that the swelling from their removal may initially look like nothing was done (although it will feel softer) or may even be bigger than it initially was. It takes several weeks for enough swelling to go down over the spot to reach the ‘benefits’ phase. It could also take several months for the area to maximally smooth as the overlying soft tissues need to shrink back down and reattach to the reduced bone area.

It is no surprise that men make up the vast majority of skull bump removals with shorter hairstyles or shaved heads where their prominences are easily seen.

Dr. Barry Eppley

Indianapolis, Indiana

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