Like many ancient Andean societies, the Paracas culture participated in artificial cranial deformation. Of the excavated and accessible skulls from the Paracas Cavernas, the vast majority of skulls were visibly modified. The skulls were observed to be primarily of two shapes: Tabular Erect or Bilobate. Though Tabular Erect was the most common among both Sєxes, Bilobate skulls were observed at a much higher rate in female skulls. This ᴀssociation with Sєx has evidence in some Paracas ceramics, where men and women are depicted with distinctly Tabular Erect and Bilobate heads, respectively.

Some archaeologists suggest that Andean conceptions of gender and cosmovision could support a quadriparтιтe (masculine–masculine, masculine–feminine, feminine–masculine and feminine–feminine) construction of gender that could explain the decisions of alteration type per Sєx. Cranial modification shape appears not to be tied to social status (based on burial goods), or kinship (based on groupings of remains).

The Paracas culture also shows evidence of the earliest trepanations in the Americas, using lithic scraping and drilling techniques to remove sections of the skull. The likely motivation for trepanation may have been to treat the depressed skull fractures that are commonly observed in Paracas culture remains, likely caused by the slings, clubs, and atlatls commonly found in mummy bundles along the south Peruvian coast. However, many of the Paracas trepanations remove such a large amount of the skull that direct evidence of skull fractures or similar injuries coinciding with trepanation is elusive. Observed trepanations and skull fractures are both most common on the front of the skull, lending indirect support to an ᴀssociation between the two.

Based on the level of bone reaction and healing observed in a trepanned skull, archaeologists can estimate the survival rate of these medical procedures: 39% of patients would have died during trepanation or shortly after (with no bone reaction being observed), and nearly 40% of patients would have survived long-term (with extensive bone reaction being observed).Currently, the best estimate of the frequency of trepanations in the Paracas culture is around 40%, though sampling bias in the initial selection of skulls, the large quanтιтy of unopened mummy bundles, and the 39% mortality rate of Paracas trepanation make an estimate this high very unlikely.

The elongated skulls found in Paracas, Peru, have been the subject of much debate and speculation. These skulls are believed to be the result of a practice known as cranial deformation, where the skull shape is altered intentionally through binding or other methods during infancy. This practice was documented among various ancient cultures, including the Paracas culture, which existed in the region from around 800 BCE to 100 BCE.

Some researchers argue that the elongated skulls are authentic and represent a cultural practice, while others have suggested they may be the result of genetic mutations or even extraterrestrial origins, though these claims lack substantial scientific evidence. In recent years, DNA analysis of some of these skulls has been conducted, but the results have often been misinterpreted or sensationalized.

In summary, the elongated skulls are real artifacts of ancient human practices, but the interpretations surrounding them can vary widely, often influenced by pseudoscientific narratives.