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Aesthetic skull shape abnormalities are not rare and their presence and significance is up to the interpretation of the patient…like all aesthetic concerns. While aesthetic face and body shape concerns are more common and as a result better appreciated, head shape concerns in my experience are unique. Affecting men more frequently than women (80:20) due to greater exposure for the obvious reason (lack of hair), they seem to affect many of the so affected more deeply and passionately than many aesthetic facial concerns.

In the Published Ahead of Print August 2020 issue of the Journal of Craniofacial Surgery an article was published entitled ‘The Effect of Cranial Shape on Esthetic Self-Worth in Bald Men’. To determine the impact of aesthetic skull deformations  and their impact on self-esteem in fifty (50) adult bald men, participants filled out a questionnaire about how they and others felt about their head shape as well as to grade their aesthetic craniofacial features using a visual analogue scale. The cranial proportions and symmetry were measured using plagiocephalometry.

Their study results showed that no significant correlation was found between cranial circumference, width or length and amount of comments on cranial shape, cosmetic assessment of appearance or cosmetic assessment of cranial shape. On average, teeth and eyes were given the highest cosmetic value while eyebrows and chin were given the lowest scores.

They concluded that cranial shape does not have a significant impact on the amount of comments received on cranial shape, nor the cosmetic assessment of either overall appearance or cranial shape in bald men. For bald men, eyes and teeth are more important craniofacial features in cosmetic assessment. Thus there is no need to treat aesthetic skull deformations in adult men.

While this study was done from the standpoint of determining whether helmet therapy should be done in adult bald men for skull shape concerns (which wouldn’t work anyway), this study is the antithesis of what I have observed in treating skull shape concerns in men in general and in short hair or bald men in particular. Having done hundreds of reductive and augmentative skull reshaping procedures, I have been impressed with the depth of concern these men have about their head shapes. (which is obvious since they were willing to undergo surgery to improve it)   While some men present with a shaved or bald head already, an equal amount if not more are having surgery in preparation for losing their hair and/or wanting to shave their head.

My experience in actually treating skull shape concerns in men contradicts this study’s findings. The difference is that this study randomly choose patients to study while my patients were specifically choosing to undergo surgery. This suggests

Dr. Barry Eppley


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