Custom made skull implants are the best way to perform almost any type of skull augmentation. Covering potentially large surface areas of the skull in a smooth manner is very difficult when attempted by traditional bone cement materials. The computer designing process does what no surgeon can do as well with the naked eyes and their own hands. While the computer design process can make whatever implant dimensions the surgeon chooses, the question is always what exact aesthetic will it create and whether this aesthetic result meets the patient’s head shape goals.
In some rare cases the patient may desire some reductive modifications to their skull implant. (additive modifications usually require a new implant) This is most likely to occur after the implant is in place or after the patient has ‘worn it for awhile’. Like all other facial implants such modification is possible through an implant shaving process. Unlike facial implants, however, the skull implant has a much large surface area which makes it more challenging to make the changes smooth and even on a curved surface. This requires a larger than normal scalpel blade and good experience in such implant manipulations.
Most commonly reduction of a custom skull implant is to reduce a certain area of thickness or to remove one of its contours. Such reductions need to be done over a much larger surface area of the implant than one would think. As a result it also requires a wider amount of incisional exposure than one may want to do. But good results from such implant modifications come from not trying to do so from limited exposures where visibility is compromised and the pocket for instrument manipulation is too restrictive.
Dr. Barry Eppley
Indianapolis, Indiana