How Can I Improve The Residual Depression After A Custom Skull Implant For My Craniotomy Defect?

Q: Dr. Eppley, I had  a TBI a few years ago. My doctor did covered it after medicaid approved it, but the company who made the implant didn’t do the scan of my head the right way so I still have small dent on my head.

A:If I understand your surgical history it appears that you had a custom skull implant for a craniotomy defect. This appears to have been in the left fronto-temporal area. I suspect the contour defect you are seeing is not the result of an ill-fitting or improperly made implant but due to the loss of the temporal muscle over it. This is very common in the temporal region as the muscle is stripped off to access the bone and, although it is sutured back up, it always atrophies and creates a soft tissue contour depression. You could prove that by a postop 3D CT scan.

So this is more of an issue of soft tissue augmentation than bone augmentation per se. Options include fat injections, ePTFE sheeting or a custom made implant overlay….each  with their advantages and disadvantages.

Dr. Barry Eppley

World-Renowned Plastic Surgeon