Custom skull implants are the definitive method of any type of significant aesthetic skull augmentation. With a design based on the patient’s 3D CT scan implants can be designed to achieve almost type of head augmentation a patient desires. (provided the implant volume does not exceed the scalp’s ability to stretch to safely accommodate it) Usually placed through very small scalp incisions I usually create many holes through the implants in surgery prior to their placement to allow for tissue ingrowth afterwards. (perfusion holes)
Like any other aesthetic implant there is always the potential for malpositioning during surgery given that much of the implant placement is ‘blind’. (not visualized) This is an issue often not appreciated by patients but the use of a small scalp incision does not provide the clear visualization of the implant like one sees on the preoperative design file. Only a small portion of the implant is seen through the scalp incision and this is also where the microscrew fixation is applied.
If there is any concern about how a custom skull implant is positioned on the bone, to determine if the edges are fully laid out, or how a multi-piece implant is fitting together along the seam lines, a postop 3D CT skull scan will provide a clear answer. The solid silicone material is fully seen in the 3D CT scan as well as the perfusion holes through it and the small screws used to secure it.
Perfect midline positioning can be hard to achieve given the blind nature of the implant’s placement even if it looks symmetric at the incision level. A few almost undetectable degrees of midline shift of the implant at the incision level become magnified at the most distal end of the implant on a different skull surface.
Fortunately custom skull implant malpositioning is not common and most patients can tolerate minor shifts. But should concerns about how the implant is sitting on the skull the 3D CT scan will almost provides an unequivocal answer.
Dr. Barry Eppley
World-Renowned Plastic Surgeon