The Brain Surgery Experience
Time Heals, Sort Of
My scar was healing really well. From researching the topic I had read about some silicone products that were supposed to minimize scarring, especially for hypertrophic scars. Since I occasionally get keloid, or raised scars, I was pretty paranoid that I would end up looking like someone who was into tribal body mods with a fat pink scar going from ear to ear on my bald head.
I ordered some tubes of silicone from ScarEase. I also realized that there were similar products available at most drug stores in the form of self-adhesive strips. I bought some strips made by Neosporin called ScarSolution. Over the months I was using them in 2004 I noticed a number of other similar products began appearing on the shelves. I guess the word was out.
In my experience these products work beyond all doubt. I started by testing them on a very visible and raised scar I had from my shoulder surgery while waiting for my head to fully heal and the scabs to disappear. The scars on my shoulder really got flatter and less red.
Once my head was ready I started slapping them across my scalp. On the sides of my head where the scar went into the hairline I would use the gel and cover them with the strips to keep it from rubbing off while I slept. I was wearing a ball cap to work every day so it was easy enough to have the strips on most of the scar all day long. Again, this stuff works. The scar, also helped by the passage of time, became colorless and there is nothing left but a very slight intermittent groove.
That’s the good news. The bad news is that as the scar was healing a very noticeable dent began to appear along the top/side of my head, right next to the scar. As it was explained to me, the reason for this is because of the way they replace the piece of skull they remove for the surgery. In my case this was a sizeable piece of my forehead. Instead of placing the bone back in the center of the hole with an even kerf line (the gap left by cutting it out) all the way around they butt the bone up tight near the brow. This is so there is no gap and everything looks as pretty as possible on the face. The problem is that on the top side the kerf is doubled. Also, since I had the endoscope inserted in the same general location there was another small hole.
At first none of this was visible at all. My head was subtly swollen for a pretty long time which I’m sure partially masked it. About four months after my January surgery the weather was getting better and I felt good enough to begin riding my bike again. It was about a month after I began bike commuting to work that I really started to notice the dent. One of the pads pressed right on it and I really thought it was deforming what appeared to be a somewhat malleable part of my skull. I reshaped the padding to avoid pressure on that part of my head.
When I had a follow-up with my main brain surgeon in June I asked about the dent and told him about the helmet. He dismissed the helmet as the problem, but I’m still not sure it didn’t at least exacerbate things. That’s when he explained the kerf and the alignment of the skull piece. I remember in one of my original visits I was told that the skull was sealed with a coral-based cement and held in place with three sets of small strips and screws. I suspect that as the cement dissipated and the growing bone replaced it the bone just didn’t come back as thick as it was. Which I believe is usually the case when a bone break heals. I’m just guessing about the cement. A doctor may read this and laugh. I assume that my skull is pretty thin where the dent is.
As far as the screws go it can accurately and literally be said that I have a screw loose. To hold the replaced skull section in place surgeons typically use three sets of two screws and one strip. Each small strip has a hole for the screw on each end. One end gets screwed into the piece of skull being put back and the other end gets attached to the rest of the skull.
Before I had surgery I remember one of my doctors mentioning the screws and how they are below the surface, etc. “Occasionally I’ll get a patient calling me at night saying ‘I can feel the screws!’ And when I ask them where, it’s not even where we operated.” With that in mind, when I started to feel what seemed like a screw I thought maybe I was just imagining it. And it was pretty far away from where the cyst had been as well. I asked the doctor when I met him in June and he told me “Yes, that is a screw, and I’m not going to tell you where the other five are” with a chuckle. It’s not that obvious, but you can see it and it feels weird if I rub my head.
So, I could live with the scar, but the dent had me bumming. I was still wearing a ball cap at work and most public places. That can often make certain situations awkward. Fortunately I work in a very casual environment. I asked the brain doc if he could recommend someone to do some “reconstructive” surgery. He said he would check into it. Eventually I got the name of a top-notch plastic surgeon. As you might expect this type of practice doesn’t work with insurance, and my insurance company doesn’t work with anyone unless you jump through a lot of hoops. I decided to bite the bullet and just pay for it myself. I didn’t think it would ever be considered a “medical necessity.”