Head shape concerns are common across all ages. The desire for a more symmetrical head often leads people to investigate various corrective methods. The path for correction is largely determined by the individual’s age and the underlying cause of the shape variation. Because the skull changes dramatically from infancy to adulthood, successful reshaping techniques are completely different for each age group.
Mechanisms Leading to Cranial Asymmetry
The differences in skull structure between an infant and an adult dictate the potential for reshaping. An infant’s skull is highly malleable because the bone plates are separated by fibrous joints called sutures, which remain unfused to allow for rapid brain growth. This flexibility makes the skull susceptible to external pressure, leading to positional molding. Positional plagiocephaly is an asymmetrical flattening of one side of the back of the head, while brachycephaly is a symmetrical flattening across the entire back of the head. These are the most frequent examples of external pressure at work.
A distinct cause for head shape variation in infants is craniosynostosis, which occurs when one or more cranial sutures fuse prematurely. This condition restricts brain growth perpendicular to the affected suture, leading to an abnormal head shape that requires immediate medical attention.
Once the sutures fuse, usually by early adulthood, the skull becomes a rigid, fixed structure. Adult asymmetry can be a residual effect from uncorrected infant issues or acquired later in life, such as post-traumatic deformation or genetic variations. Since the adult skull cannot be molded, correction methods rely on camouflage or surgical augmentation.
Non-Surgical Correction Methods for Infants
For the majority of infants with positional flattening, non-surgical repositioning is the first and most effective course of action. These strategies are successful when implemented early, ideally within the first four months of life, while the skull is most pliable. The primary goal of repositioning is to relieve constant pressure on the flattened area, allowing the skull’s natural growth to round out the contour.
Tummy Time and Awake Repositioning
A fundamental part of this conservative approach is supervised “Tummy Time,” recommended to begin soon after birth. Tummy Time involves placing the baby on their stomach while awake and supervised. This activity strengthens neck, shoulder, and trunk muscles, which improves head control and reduces the amount of time the back of the head rests on a flat surface.
Newborns should start with brief sessions, aiming for a total accumulation of 20 to 30 minutes daily. By about four months of age, the goal should increase to approximately 90 minutes throughout the day. Parents can encourage the baby to turn the head away from the flat spot by arranging toys or stimulating objects on the non-flattened side during playtime.
Sleeping and Holding Techniques
Repositioning techniques also extend into the baby’s sleeping and holding routine, though safety guidelines must be strictly followed. The baby must always be placed on their back for sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS). While asleep, parents can alternate the direction the baby faces in the crib, encouraging the baby to turn their head toward a point of interest outside the crib.
During feeding and carrying, parents should alternate the arm used to hold the baby to ensure equal pressure distribution and promote bilateral neck muscle use. For example, if a baby has a flat spot on the right side, holding the baby predominantly in the right arm encourages the baby to look left. The use of wedges or specialized sleep positioners within the crib is not recommended by the American Academy of Pediatrics.
Cranial Remolding Orthosis (Helmet Therapy)
If positional flattening is moderate to severe and does not improve after several months of consistent repositioning, a cranial remolding orthosis, often called a helmet, may be prescribed. Helmet therapy is most effective when initiated between four and six months of age, during the period of fastest head growth.
The custom-fitted helmet works by applying gentle, persistent pressure to the prominent areas of the skull while leaving room for the flat areas to grow into a more rounded shape. The helmet must be worn for up to 23 hours per day, only removed for bathing and brief skin checks. The average course lasts between three and six months, but effectiveness decreases significantly after 12 months of age because the skull begins to harden.
Advanced and Surgical Approaches for Adults
For infants diagnosed with craniosynostosis, surgery is required to correct fused sutures and provide space for the growing brain. The timing and type of surgery depend on the specific sutures involved and the baby’s age.
Surgical Correction for Infants (Craniosynostosis)
Minimally invasive, or endoscopic, surgery is often utilized for infants under six months of age. This technique involves small incisions to release the fused suture, resulting in less blood loss and a shorter hospital stay. This approach usually requires the infant to wear a specialized post-operative helmet for up to a year to guide the skull’s growth.
For infants older than six months, or those with more complex fusion patterns, an open cranial vault reconstruction is performed. This procedure involves removing and reshaping the skull bones, which are then stabilized with resorbable plates and screws.
Adult Correction (Cranioplasty and Camouflage)
In adults, where the skull is rigid, head shape alteration is achieved through cranioplasty, a major surgical procedure that is often reconstructive or cosmetic. Cranioplasty involves augmentation or reshaping of the skull using synthetic materials or bone grafts.
For cosmetic augmentation, such as building up a flat area on the back of the head, surgeons may use bone cement like polymethylmethacrylate (PMMA) or custom-designed implants made from materials like PEEK or titanium mesh. This surgery corrects severe congenital asymmetries, addresses defects left by trauma, or is performed for aesthetic reasons.
Non-surgical options for adults focus primarily on camouflage. Minor asymmetries, particularly a flat back of the head, can be disguised through strategic hair styling. Techniques like layered haircuts or high ponytails can create the illusion of a rounder, more symmetrical head contour.