Custom skull implants can make for some remarkable changes in the shape of the head. Besides being able to make a head augmentation change that is otherwise not possible by any other means one of the advantages of a custom implant design is to create a shape that blends into the surrounding skull in a more natural manner. At the entire perimeter of the implant it’s edges must blend into the adjoining skull in a smooth manner. The edge of the implant must have a feather edge to do so and this is an important consideration in its design and manufacture.
The shaved head male represents the severest test of the implant edge transition into the skull. The light reflections on a smooth curved head is quite revealing of what may lie undernmeath. While the scalp may be thick it doesn’t take much of an edge to be visible. Even a 1mm implant edge may become visible. This can create a visible indentation on the overlying scalp along an implant edge transition.
Another cause of a postoperative scalp indentation is that a skull area that needs augmented may be missed in the design. This is not because it is not apparent on the skull model during the design. Rather it only becomes apparent postoperatively after the skull implant is in place and its effects on the overlying scalp are fully seen.
Fat Injection Flow for Scvalp Contouring Dr Barry EppleyRegardless of the cause of an area of scalp contour deformity an effective secondary treatment technique is fat injections. While injecting fat has a long track record of success in the face and body its use is less well known in the scalp. But the scalp is an excellent area for fat injections particularly for small contour augmentations. In my experience the take of the fat graft is fairly good. The very fibrous nature of the scalp tissue requires that the injected fat is not too dense/compact so that it can have a more linear flow.
Scalp Contouring with Fat Injections Dr Barry EppleyThe fat injections can be placed either into the midst of the five scalp layers or can be placed down at the bone level. Given that an implant is down at the bone level the fat injections are best placed into the moe dense scalp. This requires a small injection cannula and a back and forth motion to create adequate space for the fat.
Fat injections have the advantage of being able to be placed directly into a small depressed area without an incision or disturbing the underlying implant. It also has the advantage that the worst that can happen is that the injected fat does not take well…and can be repeated if desired. This its unlike trying to add a small implant to achieve the same effect which has distinct disadvantages should it not adequately solve the contour problem.
Dr. Barry Eppley
World-Renowned Plastic Surgeon