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Background: Physically changing one’s height in adults can be accomplished by a variety of non-surgical and surgical methods. The historic non-surgical method was the placement of lifts in one’s shoes to the most contemporary method of lower limb lengthening. Shoe lifts are the simplest method and height increases of up to 1’’ are usually obtained. (women in heels can do much more) Limb lengthening by osteogenesis distraction is the most involved surgical method but height increases of two to four inches is possible.

Another less known method of ‘heightening’ are skull implants. While placing an implant on the top of the head seems like a relatively obvious choice, there have not been good methods to do so in the past. But with today’s custom skull implant technology virtually any type of skull implant can be designed. The challenge is to do so with an implant that is capable of being placed without excessive scarring and within the tolerance of what one’s natural scalp stretch can accommodate.

When designing custom skull heightening implants there are several important preoperative  considerations. First and foremost the point of maximum height projection of the implant and the implant’s volume must consider how the scalp will stretch to allow it to be safely inserted without incisional healing problems. In other words based on the height desired is a first stage scalp expansion needed? Secondly it is important to realize that the implant can just not be mainly a vertical increase. Too narrow of an implant base will give an odd look to the head shape. The implant base must be broader and cover much more of the skull’s surface area than one may think to allow the increased head height to also be associated with a more normal head shape.

Case Study:  This young male specifically requested a skull implant with the purpose of increasing his height. He need to have a 20mm height increase to be able to join his country’s military. He was offered a two stage skull augmentation approach with the first stage of a scalp expander as the most assured way to reach this implant thickness number safely. But he was unable to do do. Thus a maximal thickness/volume one stage implant was designed of 15mm thickness and 175cc volume.

The implant had a broad footprint design to blend in more naturally with his head shape and not stick out like an abnormal protrusion on the top of his head. Vertical wedges were also made in the design for material relief on the inside of the implant which would allow it to more easily be folded  for its insertion during surgery.

Under general anesthesia and in the prone position, a 9 cm horizontal scalp incision was made on the upper back of the head. Through this incision the entire scalp was elevated off of the bone from the forehead back to the nuchal ridge and then along the entire sides over most of the temporalis fascia. The skull implant was prepared by making multiple perfusion holes in it. The implant was folded into tight roll and passed through the incision. Once inside the incision it was unfolded and positioned in the midline using the compass marker on the upper occipital region of the implant.

Skull heightening implants can add up to close to an inch of height. Equally it creates a fuller rounder head shape. With a first stage scalp expansion greater height increases are possible.

Case Highlights:

1) One way to vertically heighten is a custom skull implant.

2) Modest height increases can be obtained by the immediate insertion of a custom skull implant, more significant head height increases requires a two stage process with a first stage scalp expansion.

3) Thicker custom skull implants require innovations in design for insertion and placement through small scalp incisions.

Dr. Barry Eppley

Indianapolis, Indiana

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