Custom skull implants are the most contemporary and effective method for correction of various flat spots on the head. One of the most common locations to do so is the back of the head which is the common affected skull region due to in utero and after birth head positioning. While there are limits as to how much implant volume can be tolerated based on scalp stretch, good shape improvements can be obtained.
Most back of head skull implants have a convex shape that wraps around the back of the head onto the sides and top. While this large surface area is very important to get a better back of the head shape that blends into the surrounding skull and looks like it belongs there, it does pose challenges for placement. Making as small a scalp incision as possible is an important element of any aesthetic skull reshaping procedure and clearly the implant can not be placed using the ‘pizza into the oven’approach.
Fitting the skull implant through such a small incision requires considerations in the design as well as for its insertion. Because it is a solid silicone implant it is flexible. This flexibility enables it to be rolled into cylinder to pass with less diameter through a much smaller scalp incision then one would think. As a general rule the incisional length can be reduced to 1/3 of the implant’s diameter. Because the implant is thickest at the central area getting it to fold into a roll can be difficult. This can be helped by incorporating into the design partial thickness longitudinal implant removal wedges. Three of them are adequate with the deepest being in the center area. This does not affect the outer smooth shape of the implant since they are only partial thickness.
Getting the implant through the incision is the first challenge, unfolding and getting it into position is the next one. But at least the scalp incisional length has been minimized. (purple line)
Dr. Barry Eppley
Indianapolis, Indiana