Background: One of the most common aesthetic skull deformities occurs in women with concerns about the shape of the back of their head. Lack of adequate fullness at the vertex and upper occipital region creates a flatness that promotes some women to compensate by puffing up their hair to hide it. This is such a common concern that there are even commercial products made to fit under the hair to create that effect. (bump it hair accessories)
Augmentation of the skull in the flat area (occipital augmentation) can correct the aesthetic skull deformity. This can be using a variety of materials and the decisions are about what material and the incision needed to place it. Historically bone cements (e.g., PMMA) were the common method of occipital augmentation placed through a fairly long scalp incision. A more contemporary method is the fabrication of a custom implant made of silicone material that is designed from the patient’s 3D CT scan.
The use of a custom occipital implant requires a design that can adequately correct the skull deformity but not be too big that the overlying scalp can not accommodate it. There is no exact science as to how much occipital skull augmentation any patient can take but my experience indicates that 12mm to 15mm at the height of augmentation would be the maximum. This would require a longer scalp incision to be placed. If done through more distant and limited incisions the maximum thickness of the implant should be closer to 10mm to 12mms.
Case Study: This 30 year old female desired to have greater occipital fullness to create the ‘bump it’ effect. She was tired of having to fluff up her hair to create that fullness and sought a permanent solution through skull augmentation. She opted for a custom implant design that was done using a 3D CT scan of her skull.
Under general anesthesia in the prone position, a low occipital incision was made at the bottom of her hairline. A wide subperiosteal pocket was made up over the back of the occiput to the vertex. The custom occipital implant was perforated with multiple 3mm perfusion holes and inserted. It was positioned as high up on the occiput as possible. A single 1.5mm titanium screw was used to secure its midline position. The scalp was closed in multiple layers with dissolveable sutures.
The custom occipital implant is a very effective method for creating a permanent internal ‘bump it’ effect. The custom design must balance the thickness and dimensions of the implant versus how much the scalp can stretch to accommodate it. There is also the issue of the location and length of the incision to place it. If the implant is not too big it can be placed with relative ease through a low hairline occipital incision.
Highlights:
1) Inadequate fullness or flatness of the back of the head is a common aesthetic skull concern amongst women.
2) Occipital augmentation can create the ‘bump it’ effect that some women want to create more fullness at the top of the occipital bone. (vertex)
3) A custom occipital implant is the most effective method for creating increased skull fullness at the back of the head.
Dr. Barry Eppley
Indianapolis, Indiana