Your Questions

Q: Dr. Eppley,  I have a 16 yr. old son who was diagnosed with plagiocephaly at a year old.  He wore a helmet for several months and I’ve tried various therapies over the years but at 16 his head is still a little flat on the back right side of his head.  It’s really only noticeable from a bird’s eye view and not straight on.  He never talks to me about it and it is slight but I would like to offer him an alternative if it becomes bothersome to him.  I’ve read about the injectable kryptonite and want to learn more about this.  My son is a soccer player so I wanted to ask you if heading the ball would be an issue with this if he were to ever have the procedure done.  Thanks so much!

A: The surgery that I have evolved to today with a unilateral occipital plagiocephaly is a minimal incision cranioplasty using PMMA.  (acrylic bone cement) The kryptonite material is no longer available. This is the same technique only using a different material. Through a 1.5 inch incision in the scalp, the material is placed into position using a funnel technique and then shaped externally as it sets. Most patients need somewhere between 30 and 60 grams of material to provide better skull symmetry between the two sides. This material is actually stronger than bone so it is more resistant to blunt head trauma than your native skull bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q : I have a deformity of the skull known as plagiocephaly. I stumbled across your site a few days ago and a sudden feeling of relief came over me. For the first time in my life I feel as if there is hope for me. I would like to know what can be done to correct the condition that I have. I know that nothing is perfect in this life, I am a living example of that but I would sure love to give your treatment a try. I have lived my life in the shadows, hiding away from the world. I think that Dr. Eppley will help me live for once.

A: Plagiocephaly, meaning crooked or twisted skull, affects more than just the shape of the cranium. Since the face is attached to the cranial base, it also is affected by how the skull develops. Untreated plagiocephaly can affect the front or back of the skull. When untreated as an infant, if severe, it can lead to a variety of predictable face, ear and skull deformities.

The first question is whether your plagiocephaly is frontal or occipital in origin. Facial photographs will make that fairly clear. Either way, the key in providing some cosmetic improvement to the craniofacial deformities is to understand what can and cannot be done. While much can be done to improve facial asymmetries,  less can be done with adult skull deformities. Forehead recontouring can be done but changes in the back or side of the skull are more difficult and much less can be done.

What I ask every patient is to make a list of what bothers you from most significant to least significant. Then we go over the list, look at what can be done, and come up with a practical and value-oriented plan for improvement. Such improvements as forehead and brow reshaping, rhinoplasty, cheek, chin and jaw angle augmentations, and otoplasty are common procedures that can be very helpful in attaining improved facial symmetry. Augmentation procedures on the back and sides of the skull can also be done but very little can be gained by any form of reduction cranioplasty.  

Dr. Barry Eppley

Indianapolis, Indiana