and is no longer present after an initial surgery to correct a bony void is performed a subsequent procedure using a pterional graft pmma filler absorbable material or tissue engineered substrate for example may be performed in order to repair the soft tissue defect the subsequent procedure may be conducted via injection of pmma percutaneously into this region or by placing a pterional flap through a small incision made in the skin however a patient will likely exhibit aesthetic asymmetry between the time of the initial surgery and the subsequent revision surgery to correct the temporal hollowing shown in fig1 a the patient specific cranial implants and methods of designing such implants of the present invention together provide simultaneous customized hard tissue i e bony reconstruction and soft tissue i e fat muscle reconstruction in a single procedure approach such that temporal hollowing is avoided and revision procedures will not be required fig2 is a perspective view of a patient 39 s skull 200 exhibiting a large irregularly shaped bone void 210 predominately positioned in the temporal lobe thereof fig3 a 3c show one embodiment of a patient specific cranial implant 300 of the present invention designed to fill a bone void such as shown in fig2 for example patient specific cranial implant 300 includes a perimeter 320 configured to contact a perimeter 220 of bone void 210 when patient specific cranial implant 300 is coupled to bone void 210 in a preoperatively planned position upon coupling of patient specific cranial implant 300 to bone void 210 plates fasteners and or adhesive glue for example may be.