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Background:  The shape of the skull is affected by numerous bony and muscle features which ultimately work together to create  an overall head shape. In a narrow head shape it is marked by a bony temporal line that is more narrow from the forehead to the back of the head. This can make the brow bones appear more prominent, the sides of the head pinched and the upper back of the head flat.

In correcting this type of male narrow head shape where the brow bones appear too pronounced a multilevel augmentation approach is needed. While brow bone reduction is the definitive treatment for prominent brow bones that is often a challenge in men. Where to put an incision in an aesthetically acceptable location severely limits the options in men. An alternative strategy is to build up the area just above the brow bones (suprabrow bone region) with a custom implant. That will soften the appearance of the brow bones as well as add some width at the lateral suprabrow area as well.

For a narrow head shape all the skull area lateral to the sagittal crest must be build up. This is a gradual buildup that flows over the lateral bony temporal line to blend into the upper temporal muscle region. Since the narrow shape almost always has a flat upper back of the head the augmentation must wrap around the upper back of the head creating a horseshoe-shaped type of augmentation.     

Case Study: This male desired to widen his head shape as well as decrease the strong brow bone projection that he had. He has been placing Radiesse injectable filler into the lateral suprabrow area to soften his brow bone appearance as well as add a little width to the lower forehead. With his shaved head there was no good option for brow bone reduction surgery.

Two separate custom skull implants were designed, one for the suprabrow region and the other larger skull implant. 

Under general anesthesia and in the supine position the suprabrow bone implant inserted using his existing deep midline glabellar furrow. The custom implant was inserted though a small curved scalp incision at the anterior end of the crown area.

He went on to heal uneventfully but desired some additional improvements. The lateral suprabrow implant was thinned down a bit and a new custom skull implant was added to the back to provide an additional augmentation effect. Given the size of his implant a geometric split technique was necessary to get it past the small scalp incision.

After multiple surgical efforts and implants his overall head shape showed considerable improvement in its shape.

While custom skull implant designing can make any desired shape and thickness, there is not absolute way to know for sure how effective it will be in creating the desired head shape effect. This is particularly true when there are multiple areas of head shape concerns that are separated by otherwise normal skull shape. It may be necessary for more than one surgery to optimize the aesthetic result.  

Case Highlights:

1) A narrow head shape affects the entire skull from the brow bones back to the occiput.

2) Prominent brow bones can be camouflaged by a suprabrow bone implant to lessen the transition of the brow bones into the forehead. 

3) A narrow head shape can be augmented with a custom horseshoe skull mplant that augments the back of the head and wraps around to augment the parasagittal-bony temporal lines. 

Dr. Barry Eppley

Indianapolis, Indiana

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