Your Questions

Q: Dr. Eppley, I am looking to fill the dent in the back of my head to achieve a more normal, round head. My flat spot/indentation is very obvious and noticeable from certain angles. It is located in the back left side of my head, a bit higher and closer to the top of the head. The dent leads to another minor flat spot right where the head curves from the top to the back. What I would like is an injectable cranioplasty operation and suggestions if there are any better options. Also, what is the recovery process of the operation? Thank you very much and your feedback and insight is tremendously appreciated.

A: Injectable cranioplasty is a technique that I have developed to avoid any significant scalp scarring with limited build-ups of the skull. Small back of the head indentations/flatness are the most ideal areas. The concept is based on having a cranioplasty material that is liquid enough during its initial mixing that it can be injected and then sets in a reasonably short length of time there after. A small one inch is needed to lift the scalp tissues off of the bone and develop the desired recipient pocket. It is through this small incision that the material is injected. Once injected the material must be molded into shape from the outside through the scalp. While Kryptonite was initially the material I used, it is no longer available as the manufacturer has withdrawn it from the market. (the reason I do not know) I am now working with another calcium phosphate material, OsteoVation, which I actually like its handling properties better.

While the injectable cranioplasty approach certainly has its appeal, it is not without any downside. Its biggest drawback is that getting the material smooth is a blind procedure and rarely does it ever become perfectly even. The other issue with it is cost. These materials generally cost 2X to 3X more than conventional PMMA cranioplasty material which needs to be placed through an open incision. (about 9 cms) The guarantee of optimal smoothness shape requires an open cranioplasty approach.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I have been getting a variety of injectable fillers for chin and cheek augmentation over the past few years as I don’t have the time for surgery to get real implants. And I am not sure I want synthetic implants anyway. Is there something else that can be injected that would be permanent but would create the same volumizing effects. If there was that would great.

A: There is a real need that has developed in aesthetic facial enhancement for an intermediary procedure between temporary injectable fillers and permanent facial implants for augmentation of the three classic highlights of the face, chin, cheeks and jaw angles. The emergence and phenomenal spread of injectable filler use has created the need for this ‘in-between’ step as more and more doctors are pushing the envelope using temporary fillers as a means of facial skeletal augmentation. (even if they are not putting them all the way down to the bone) As a result, patients now seek injectable therapy for what was once exclusively a surgical solution.

The one material that shows the greatest promise as an injectable facial enhancement method are the so-called bone cements. All  bone cements are liquid and powders that go through a putty phase and then set into a hard bone-like implant. They are composed of differing forms of hydroxyapatite and calcium preparations so they are perfectly natural and 100% biocompatible. Some are now available that can be injected down to the bone level after they are mixed and then set up in just a few minutes. They can be molded while they are setting to get the desired shape, albeit blindly. So an injectable cement combines the benefits of permanency with the avoidance of a surgical incision, bigger operation and recovery and a mass of implanted synthetic material. One of these very promising bone cements is OsteoVation. A tricalcium phosphate mixture, it fulfills all of the requisite handling and insertion properties to be an injectable permanent facial implant.

Dr. Barry Eppley

Indianapolis, Indiana