Your Questions

Q: Dr. Eppley, I have few question regarding forehead augmentation and back of the head augmentation. I would appreciate your kind answers to each of them one by one.

1. Which procedure is more durable, bone cement or implant?

2. Can you please tell the advantages and disadvantages of each?

3. Is it possible that bone cement is filled without cutting the scalp, so we fill the scalp by injection three to four time(interval of ten days) and it may increase the whole head size?Because i fear of cutting scalp and tissue expander. 

4. Is bone cement strong enough like skull bone?

5. Which procedure do you recommend?

A: For forehead and occipital (back of the head) augmentation, there are two basic materials that be used…bone cement and preformed implants. In answer to your questions:

1. Both material are equally durable. Neither can degrade, be broken down or will ever need to be replaced because they ‘wear out’.
2. Each material type has its own unique advantages and disadvantages. Bone cements must be mixed, applied and shaped during surgery thus taking more operative time to do. Preformed implants are made before surgery off of a 3-D CT scan of the patient’s skull. By computer design they provide the best and most symmetrical augmentation with the least risk of any irregularities at the implant-bone transition areas. They can also be done with less operative time. From a cost standpoint, they are roughly equal.
3. With either approach, a scalp incision is needed. There is not injectable cranioplasty technique for this size of skull augmentation areas. There is no need for a tissue expander with your dual augmentation.
4. The resistance to fracture is roughly equal between PMMA bone cements and skull bone.
5. I find both procedures can make for successful skull augmentations. The choice between the two is a matter of personal preference and which one sounds better for each patient. Both type of forehead and skull implants can be done very successfully.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in skull reshaping surgery. My head shape is not normal. It is flat from the back side and inclined backward at the forehead making it smaller on the top as a whole. My face is not much wider as well resulting in a small head. I want to increase head size especially from my back side and forehead areas. Please tell me which procedure I need whether it is an implant or bone cement filling.

A: When it comes to skull reshaping and the aesthetics of your skull, you are talking about a sagittal (front to back) deficiency. Your forehead is slanted backward (retroclined) and the back of the head is flat. (or has a reverse retroclination compared to the front. This is treated by two different methods of dual forehead and occipital augmentation. It can be done with either a bone cement filling material (usually takes 150 grams) or custom forehead and occipital implants made from  3D CT scan. There are advantages and disadvantages of either approach but the end results of either one are the same with a potentially dramatic difference in the volume of your skull from front to back.

Dr. Barry Eppley

Indianapolis, Indiana