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The custom skull implant provides the most effective method of correction of various flat skull areas (e.g., planiocephaly) or a desire for a larger skull shape. Such computer-designed implants made from a solid silicone material offer the most advantages in skull augmentation because they can be placed through the smallest scalp incision…an important consideration in any type of elective aesthetic skull reshaping surgery.

With a computer-designed implant the goal in surgery is not about whether the implant has the right shape but rather getting it into the right position on the skull. (as per the preoperative implant design) While correct positioning on the skull is critical that alone does not assure a perfect aesthetic result. One uncommon but potential postoperative aesthetic issue is that of implant edging. This means that once the scalp has fully healed back down over the implant a visible edge of part of the implant may be seen. This potential issue is most relevant in shaved head males or those men with very closely cropped hair.

Skull implant edging can occur for three reasons. First, it may be a design issue where the implant does not have completely feathered edges around its perimeter. While the scalp can be quite thick even a 1mm edge poses a risk of being seen. Secondly, the subperiosteal tissue pocket into which the implant is placed may be slightly less than the size of the implant causing one of its edges to buckle or flex upward. Third, the very thin edges of the implant may not have gotten completely unfolded once inside the subperiosteal scalp pocket. (the pocket may be adequate but the implant has not returned completely to its full shape after being folded to pass through the incision)

While a custom skull inplant that has a design issue with its edges can not be solved without removal and replacement, an inadequate pocket size or a folded implant edge can be more easy resolved with a minimally invasive procedure known as a ‘skull implant capsulotomy’. In this procedure a very small incision (5mms) is made through which an elevator instrument is introduced. This instrument is used to open up the enveloping scar around the implant (capsule) which will either permit more space to be created so the flex in the implant is released and it lays down completely flat and/or the implant edge is allowed to unfold. The instrument sweeps along the entire area of the externally visible implant edge.

While this does involve using a small incision it is still largely a closed capsulotomy procedure. For many patients this procedure can be performed under local anesthesia. While I have only needed to perform this procedure three times in doing hundreds of skull implant placements, it usually provides a good resolution to the problem.   

Dr. Barry Eppley

Indianapolis, Indiana

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