On Halloween today I was performing a custom skull implant for a female for crown skull augmentation and the pattern of the scalp incision used looked familiar and appropriate for this day. The scalp incision seemed similar to that of a Jack O’Lantern’s smile. Its irregular and jagged appearance was reminiscent of a shape that might be carved on a pumpkin at this time of year.
But on a serious note, this type of scalp incision commonly used for the placement of custom skull implants has a very specific purpose that is not done for artistic reasons. Since no hair is shaved for this surgery it becomes obviously necessary to part the hair to do the surgery. Even with the best effort at parting the hair a perfectly linear line or pathway is never created. But this is not a disadvantage since a straight line incision/scar in the hair-bearing scalp is not preferred.
With hair an irregular scalp incision line is preferred because it hides the ultimate scar better. Thus making an incision between the hair shafts in an uneven part is an aesthetic advantage. Not only does it hide the scar better but it does more than just making an irregular line that is visually harder to follow. It also helps with a better scar outcome because, by making it between the parted hair shafts, it avoids cutting across and damaging hair follicles. With little to no hair loss after surgery the scar is better hidden as many scalp scars are more obvious because of hair loss along the scar line.
In custom skull implants the aesthetic outcome of the incision used to place it is of great aesthetic significance. While every surgical incision made creates a scar, lessening its effects is an important intraoperative strategy.
Dr. Barry Eppley
Indianapolis, Indiana