The skull is a major structure in our body that plays a lot of different roles. As the primary structure that composes the internal architecture of the human head, the skull defines the structures that form our face, and protects the brain. There are a large number of bones that form the different parts of the skull. Sometimes during childbirth, due to trauma or a disorder of some kind, these structures can become malformed. Many times, these types of malformations can be treated with cosmetic skull reshaping.
The human skull has a wide range of small differences due to race, gender, age, and genetics. However, generally, there is a desire for smooth surfaces, gentle curves, and a consistent shape. On a cosmetic level, the skull’s shape is mostly hidden by hair, which covers up most of the subtler abnormalities. For those that are balding or have shaved heads or short hair, skull shape abnormalities can be problematic for the appearance.
Dents, depressions, or bumps that significantly alter the skull’s shape fall into the category of craniofacial abnormalities. This category covers a wide range of deformities of the head and facial structure. The abnormalities aren’t known to be tied to a single factor but rather a combination of genes, environment and folic acid deficiency can have an effect on the development of head and facial bones.
One of the most common types of skull reshaping is due to a condition called craniosynostosis. Craniosynostosis is a condition where the growth pattern of an infant’s skull is changes because one or more of the joints of the child’s skull fuse prematurely. This results in a reaction where the skull compensates by growing in an exaggerated direction in order to create space for the brain. Sometimes, the exaggerated growth fails to create enough space, which can lead to intracranial pressure, a condition that may lead to sleeping problems or the impairment of mental development.
Skull reshaping generally works towards reducing high spots or adding dimension to depressions. The amount of reshaping and augmentation is constrained by the scalp’s ability to stretch, which is estimated to be 10-15 millimeters in one procedure.
For skulls that are overly wide, temporal reduction is often the strategy for reshaping. The temporalis muscle is a large muscle structure that is attached to the side of the head, above the ear. This muscle can be shorted and partly removed. Combined with some bone thinning, temporal reduction can reduce the width of the skull.
With divots, depressions, or areas where the skull is sunken, synthetic materials are used to add size and reshape the skull. Some of the types of materials used are called bone cements, acrylic PMMA, or hydroxyapatite. The cements are powdered or liquid materials that are mixed into a shapeable mold and set into the skull to harden.
For patients with history of craniotomy with skull defect, cranioplasty reconstruction can be done with autologous (own bone) or with, one of the newest types of techniques is the use of a custom skull implant. The implants are constructed using a 3-D CT scan of the patient’s skull for an exact fit. Silicone-based, titanium mesh or peek implants, are augmentation implants are designed by computer for a precise shape and then inserted surgically.
The surgery is always performed with general anesthesia and involves an incision in the scalp. Hair is kept intact, and the incisions are closed with reabsorbable sutures.
The most important step to take is to consult with an experienced plastic surgeon like Dr. Berhane if you have any questions. Contact us today for a consultation.