In large skull augmentations there is a necessity for expanding the scalp to accommodate its volume. This is done by a first stage scalp expander process using a specially designed ‘balloon’ that acts much like the pregnancy process. While the expander requires surgical placement the expansion process is done by the patient over the following months. This is accomplished by the remote port that extends outward from the bag or balloon into which the fluid is instilled.
The port is buried under the scalp and placed away from the expander proper towards the ear. Which ear it is placed next to depends the dominant hand of the patient. Since many people are right handed (85% to 90%) the port is placed closer to or above the right ear. But if the patent was left handed then it would be the left ear. The port will eventually appear as a prominent bump in the scalp that is easy to identify but easily after surgery the scalp swelling may partially obscure it and make it harder to find. In patients with hair the port is never seen even though it is a prominent bump.
No fluid is usually placed into the expander at the time of surgery. The first saline expander fill is done in the office before the patient goes home as an instructional session on how to do the inflations. While the concept of expander inflations is straightforward it has its challenges for the patient based on who is doing it. Another person doing the inflations is the obvious easiest method.
But in many cases the patient has to do their own inflations which poses some technical challenges. We provide all the loaded 10cc syringes with saline as well as the needles to do the injections. The usual fill goal is 200ccs performed over a 2 to 3 month period, injecting 10ccs every few days.
It is a learned skill to do one’s own injections but everyone who needs to do so has been successful. I place the port as close to the ear as possible to provide better visual access to do the inflations. With the non-dominant hand the port is localized and then the dominant hand is used to do the injections. A few patients have created their own devices to help localize the port so they only need one hand to do the injections. (plastic bottle cap with a hole in it connected to a strap)
Dr. Barry Eppley
World-Renowned Plastic Surgeon