Of the forms of human self-mutilation that have been recorded, few have been so widespread and long lasting as intentional cranial deformation. The earliest known record of the practice is from Iraq and dates back to 45,000 BC. The custom, which was practiced in many areas of the world, continued well into this century. Although tatooing, ear piercing, and circumcision are commonly practiced in our society, cranial deformation has almost completely disappeared from contemporary cultures, with the exception of isolated groups in Africa and South America. Intentional cranial deformation is intriguing for those who study the human cranium.