Custom skull implants provide the most precise and effective method for permanently augmenting the back (occipital) and top (parietal/vertex) of the head. Unlike bone cements, a custom skull implant is designed from the patient’s own high-resolution 3D CT scan, allowing it to exactly match the contours of the skull while creating the desired increase in head height, width, projection, or overall shape. This patient-specific design produces smooth transitions between the implant and the surrounding skull, creating a natural appearance that cannot be achieved with bone cements, fat injections or injectable fillers.
The most common reasons for combined back and top of the head augmentation include correction of a congenitally flat back of the head, increasing overall cranial volume, creating a more rounded or fuller cranial shape, improving the proportions of a narrow or elongated skull, and enhancing the masculine or feminine profile of the head. Some patients seek surgery after previous craniofacial procedures, while others simply desire a more balanced cranial contour for aesthetic reasons.
The implant design process begins with a 3D CT scan of the skull. Computer-aided design (CAD) software is used to create an implant that adds volume only where it is needed while maintaining smooth contour transitions. The implant can be made to augment only the occipital region, only the top of the skull, or—as is often preferred—a single continuous implant extending from the upper occiput over the vertex. Because every skull has unique dimensions and asymmetries, each implant is individually engineered to match the patient’s needs.
Aesthetic ustom skull implants are manufactured from solid medical-grade silicone. Silicone offers several advantages, including excellent tissue compatibility, flexibility for insertion through a relatively small scalp incision, long-term stability, and ease of modification or removal if ever necessary. Despite being flexible enough for placement, the implant maintains its designed three-dimensional shape once positioned on the skull.
Surgery is performed through a scalp incision placed low in the back of the head where the scar is well concealed within the hair. A subperiosteal pocket is developed over the skull, and the custom implant is inserted and accurately positioned. Small titanium screws are typically used to secure the implant to the skull, preventing any movement during healing. Because the implant has been designed specifically for the patient’s anatomy, only minimal adjustment is required during surgery.
Recovery is generally straightforward. Swelling of the scalp is expected during the first several weeks, while discomfort is usually mild to moderate and controlled with oral medication. Most patients return to non-strenuous activities within one to two weeks, although final soft tissue settling and the complete appreciation of the new head shape may take several months. Once healing is complete, the implant becomes a permanent part of the cranial contour and cannot be seen or felt by others under normal circumstances.
The greatest advantage of a custom implant is its ability to achieve predictable, substantial volume increases that are simply not possible with fat grafting, injectable fillers, or bone cement techniques. Thicknesses of 10 to 16mms are common, while selected patients may safely receive even greater augmentation depending on scalp elasticity and implant dimensions. The result is a permanent improvement in head shape with a smooth, natural contour that closely follows the underlying anatomy.
For patients seeking comprehensive cranial reshaping, a custom implant extending across both the top and back of the head provides the most powerful and anatomically accurate solution available. By combining advanced 3D imaging, computer-assisted implant design, and patient-specific manufacturing, this approach delivers precise, reproducible, and highly individualized aesthetic outcomes.
Dr. Barry Eppley
Plastic Surgeon