Aesthetic augmentation of the head can now be effectively done using custom skull implants made from a 3D CT scan. With 3D designing software the zone of skull augmentation can be clearly identified and an implant designed to cover it and create an improved head shape. This is a far superior technique to the use of traditional use of bone cements both in assurance of a smooth contour and the ability to cover broader surface areas.
With preoperative designing a custom skull implant can be made to cover the entire head if desired. This creates for the first time the ability to truly increase the size of the head and/or change its shape within the confines of the ability of the scalp to stretch and accommodate it.
Such large or total custom skull implants create some fabrication and surgical placement issues. From a design standpoint it is important that the bottom of the implant does extend below the equator of the skull. This is essentially a equator line drawn around the head at about the level of the lower edge of the brow bones. When the implant extends below this line it creates undercuts which can make the implant difficult to manufacture.
The large surface area coverage of a total custom skull implant creates some placement considerations. It is one thing to design it on a skull image but it can be quite different in surgery to actually place it as it was designed. While a full coronal scalp incision would make it easier to place this is usually not an acceptable approach in most aesthetic patients. To keep the incisional length as small as possible, the implant is designed to be a placed in two pieces. This will allow it to be placed in two smaller pieces and then reunited once each is placed on the bone and under the scalp.
The sides of the implant that extends into the anterior temporal region must be very soft and thin as they will be right under the skin on top of the temporalis fascia. It is not possible with a implant that sits on the bone over the top of the head to have its sides or temporal sections be under the fascia. But with very tapered edges it will not create a visible implant edge.
Dr. Barry Eppley
Indianapolis Indiana