Your Questions

Q: Dr. Eppley, My daughter has Plagiocephaly that we were told would round out on its own and were refused helmet therapy. I saw your information about skull implants. I am very interested to know if this can be used on children, my daughter is 21 months. She has 10 mm asymmetry with flattening on her back right side and left forehead.

A: While skull implants can be made for plagiocephaly patients at any age, in young children with a lot of craniofacial growth yet to occur, augmentation of skull contour defects is best done by the application of intraoperatively shaped hydroxyapatite bone cements. These materials are more biocompatible with growing bone and will integrate into the bone as the process of appositional skull growth continues. I have seen case where bone has completely grown into and/or over such applied bone cements in children.

As a general rule I do not use synthetic preformed skull implants in patients who have not yet reached near complete craniofacial growth. While they are tremendously effective and make the surgery very predictable and allow for a quicker recovery, what happens to the bone around such an implant when applied at at early age is unknown.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I want a reductionrhinoplasty that will really make my nose smaller. I have attached a picture which shows how much reduction I want. Is this possible?

A: The limitations of a reduction rhinoplasty are largely skin thickness based. In thick skin more major support reduction (osteocartilaginous structures) can be met with ‘skin resistance’. This is most manifest in the nasal tip area where thick skin has a propensity to ball up rather the than shrink down.  This results in not the desired tip refinement but a persistent wide ill defined tip despite what has been done to the tip cartilages underneath. The amount of nasal reduction you are illustrating overall I do not think is a realistic one and certainly not an advised one. Your nasal skin is thick not thin and your tip area will likely suffer the very complication of which I just described. While I do computer imaging with  the most conservative change possible, so as not to over promise any result and it is likely more reduction/refinement may occur that what is shown, I know that what you are desiring can not be achieved. At best in my hands the result may be halfway between what I have imaged and the amount of overall nose reduction you are desiring.

Dr. Barry Eppley
Indianapolis, Indiana