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Background: Skull shape abnormalities are well known and are most commonly recognized in congenital deformities. These are often fairly severe and may require early infantile cranial vault surgery. But there are a variety of more modest skull shape aberrations that affect a far greater number of people and would be considered more aesthetic in nature. Just because they are more modest in magnitude does not mean, however, that they do not cause great psychological stress and self-image harm.

The most common aesthetic skull deformity in women is that of a flat crown. The crown of the skull is the union of the back and the top of the head and represents the original posterior fontanelle area. It is aesthetically bothersome to women as it creates a skull shape where the crown is lower than the front of the skull. Women can hide such.a flat area of the skull by teasing their hair to artificially add crown height. But over time this becomes tedious and may eventually adversely affect hair growth and density.

While numerous methods can be used to augment the skull, a custom skull implant is really the best approach. Being able to preoperatively design the implant for surface area coverage and dimensional thickness as well as being able to be placed through the smallest scalp incision are major advantages. I have seen far too many women with full coronal scalp incisions with minor amounts of crown augmentation with bone cements to see its disadvanatges.

Case Study: This young female was bothered by her lack of crown height. She had teased her hair up for years to provide the volume she desired but sought a permanent augmentation method. Using a 3D CT scan a custom skull implant with the maximal projection (13mms) centered over the crown was designed. The perimeter of the implant was extended beyond the crown area significantly for a natural and more complete skull augmentation look.

Under general anesthesia and through a 9 cms posterior scalp incision, the implant was introduced and positioned. The compass marker on the implant provides the only visible indicator inside the incision to get the implant properly positioned in the correct orientation.

Aesthetic augmentation of the crown of the skull int women requires a custom implant whose blended perimeter goes well outside if the centra crown area. How much augmentation can be provided depends on how much the scalp can stretch to accommodate the implant. For women that seek more significant crown and skull height a two stage skull augmentation approach is needed with a first stage scalp expansion procedure.

Case Highlights:

1) Heightening of the crown of the skull is the most common aesthetic skull reshaping procedure in women.

2) Enlarging the crown of the skull requires extension of the augmentation way beyond that of the crown for a natural skull augmentation look.

3) A custom skull implant is by far the best method for aesthetic augmentation of the crown of the head.

Dr. Barry Eppley

Indianapolis, Indiana

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