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Of all aesthetic skull reshaping surgeries in adults, correction of the flat back of the head is the most common. It is a skull shape deformation that is shared equally by women and men as well as crosses all ethnicities. It can be a complete flattening across the back of the heador it can be an asymmetric occipital flattening from plagiocephaly.

Computer designing of skull implants is the most effective method of head shape augmentation. I would only consider today the use of bone cements by patient request and can see no advantage with their use. Designing before surgery the exact shape and location that is needed far exceeds the surgeon’s ability to hand craft a remotely similar result using bone cements. This is particularly poignant when the amount or size of the skull augmentation would place a lot of stretch on the overlying scalp.

The amount of skull augmentation that can be done on the flat back of the head is partially dependent on the amount that the scalp can stretch over it. When this becomes a limiting factor a first stage scalp expansion can be done using a tissue expander. With this two stage approach up to 25mms of central occipital augmentation can be achieved. This number may not sound like much util you consider the entire surface area of the back of head covered by such an implant that was around its sides.

Age is not a limiting factor in skull augmentation as illustrated in this 70 year-old man who underwent a two-stage approach to augment the flat back of his head that had bothered him his whole life. Two surgeries separated by 6 weeks apart were able to achieve this result in the very tight scalp on the back of the head that had congenitally lacked bony projection.

Dr. Barry Eppley

Indianapolis, Indiana

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