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Background: In the congenitally narrow head the sides appear not wide enough for the height of the skull. This is most easily seen in the forehead and anterior temporal area which appears ’pinched’ or indented. One’s hair may hide the rest of the narrow side of the head but it usually extends all the way to the back. While  the side of the head has a thick muscular layer between it and the overlying scalp (temporalis muscle), the narrowness is primarily caused by the shape of the skull bone as evidenced by the shape of the bony forehead.

When widening the congenitally narrow head the augmentation must cover the bony side of the forehead, cross on top of the muscle and end on the bony surface of the back of head. This can only be effectively done by a custom implant design which is much longer (front to back) than it is tall. (top to bottom) Such a bilateral implant can be placed, incredibly, through incisions at the back of the ear. (postauricular sulcus)

In designing these unique head widening implants the question is how wide (thick) should be and where should the greatest thickness of the implant be. As a general rule I don’t usually make such implants wider than 7mms and that width is usually centered on the side of the head above the ear. This works very well for most patients but, as often happens with many custom implant designs, the patient may discover additional areas on the side of the head that they wish augmented once seeing what the initial implant does.

Case Study: This male had large head widening implants placed with a very successful result.No edging of the implant was seen in the forehead. Despite this good result he wanted some additional augmentation on the more posterior and inferior temporal area behind the ear. Using his original 3D implant design, smaller custom posterior temporal implants were designed per his specifications.

Through his original well healed postauricular incisions the new posterior temporal implants were placed, partially on top of a portion of the indwelling implant and par of it on the posterior temporal bone. Once good position of the new implants was obtained single screw fixation used to hold them there. 

Case Highlights:

1) Widening the entire side of the head can be achieved with a custom skull implant from the forehead to the back of the head.

2) Secondary augmentation of a custom head widening implant can be done by an implant overlay technique.

3) A custom posterior temporal implant overlay can be placed through a postauricular incision. (as was the original head widening implant)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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