Background: Custom implants provide a reliable method of aesthetic skull augmentation based on their 3D preoperative design. But no matter how good an implant design is the final aesthetic result also depends on its proper placement and how well the scalp scar heals through which the implant is placed. Provided a good design and implant placement the final assessment of the result is how well the scalp scar has healed. There is no bigger test of a scalp scar than in the shaved head male…a common patient who presents for many types of skull reshaping procedures.
Case Study: This male had a top of the head asymmetry that had bothered him for a long time. The left top of his head (parasagittal-upper temporal) area was more flat/less convex than the opposite side. A custom skull implant was designed to match the other side.
Under general anesthesia a small posterior scalp incision was made where the posterior end of the skull implant would sit. Total incisional length was 3.5cms. Through this limited incision the much larger custom skull implant was placed and secured with double microscrew fixation.
He went on to heal uneventfully with a near perfect symmetry match between the two sides of his head.
The healed incision was virtually undetectable even on close inspection.
Once of the primary goals in custom skull implants is to limit the scalp scar tradeoff. This is done by initially making the incision as small as possible to pass the implant through it. How the scalp incision is closed is also important with a multilayer technique that preserves hair follicles. (even in the shaved head male they have hair follicles) Hair follicles are en important source of epithelial cells that contribute to scar healing.
Case Highlights:
1) Custom skull implants provide an effective method for improving skull asymmetries.
2) Placing custom skull implants require a scalp incision for placement which is always a concern in the shaved head male.
3) Scalp incisions in the shaved head male can heal in a near imperceptible fashion.
Dr. Barry Eppley
World-Renowned Plastic Surgeon