Background: The shape of the skull can be almost as variable as each individual in many ways. But the one similar characteristic is that most skulls do have a smooth surface from the forehead to the back across the top. This is seen in many plain skull model examples where a smooth surface is usually evident.
But despite the depiction that a skull has a smooth surface, it does not always occur. For a variety of developmental reasons drive by sagittal suture and anterior and posterior fontanelle closure, the skull may develop a variety of surface irregularities. While across the top of the top of the skull the most common irregularity is a sagittal crest or ridge, generalized lumps and bumps may appear. The skull is otherwise of normal thickness but it just isn’t smooth.
While there are undoubtably many people who do not have a perfectly smooth skull to the touch, the presence of hair provides a visual camouflage of it and makes it tolerable. But in the male who shaves his head or lacks hair coverage, the skull irregularities can be quite visible and aesthetically distressing.
Case Study: This 35 year-old male had gone from long time usage of a hair prosthesis to that of a shaved head look. In so doing he was now aware and very conscious of how the surface of his head looked. He described it as being uneven, irregular and with high spots throughout. A 3D CT scan conformed that this was due to the bony shape of the skull. His goal was to have a smooth more rounded head shape across the top. This was designed to be accomplished by making a thin skull cap implant to cover the entire top from front to back staying along the temporal lines at the sides.
Under general anesthesia, a curved posterior scalp incision was made that was less long (wide) than the implant. Subperiosteal undermining was done over the entire scalp where the implant was to be located. The implant was inserted through the incision in a partially folded fashion and positioned. Prior to placement multiple perfusion holes were made through the implant. After placement absolute stability was assured with two small titanium screws.
A skull cap implant is a slightly different skull augmentation implant in that it is designed to create a smoother skull but not necessarily a larger or more augmented one. Because it is a thin implant (in this case 6mm maximal projection at highest point) it can be inserted through a relatively small scalp incision. Because it is placed partially folded it is critical that one makes sure that the edges of the implant are laying completely flat prior to closure. Thin implant edges can easily remain folded and are hard to detect by feel and impossible to see through a limited scalp incision.
Case Highlights:
1) The normally smooth surface of the skull can in some people be very lumpy which can be visible in the bald or shaved head male.
2) A thin custom made skull implant placed over the lumpy part of the skull can create a smoother scalp surface and feel.
3) A thin custom made skull cap implant can be placed through a relatively small scalp incision.
Dr. Barry Eppley
Indianapolis, Indiana