Types of Prosthetics

Think of a facial prosthesis in the same way you think of special effects make-up that is used to change the appearance of a movie star. The facial prosthesis is an artificial device used to replace a missing or malformed facial feature. Persons needing a prosthesis may have lost part of their face as a result of cancer, trauma or a congenital birth anomaly. Facial prostheses offer various advantages and disadvantages, compared to surgical rehabilitation, which should be discussed with your craniofacial team.

The most common types of facial prostheses include:

• Ear
• Nose
• Orbital (eyes)

While a facial prosthesis can often achieve a very realistic look there are limitations to its use. They are intended to fool the casual observer in everyday social encounters such as walking down the street, riding the bus, or shopping at the grocery market. A facial prosthesis can often help to ease the anxiety associated with a casual social encounter, but may be detectable under close observation. The prostheses are created by an anaplastologist, who is part of a craniofacial rehabilitation team. An anaplastologist has special training in art, anatomy and material sciences. The practice of making facial prostheses incorporates as much art as science. Therefore, the esthetic results are dependent on the skills of the anaplastologist.

The prosthesis is sculpted first and then molded to custom-fit the individual's needs. Anatomical landmarks, facial proportion and symmetry are carefully considered to create a convincing, life-like facial feature and silicone rubber is most commonly used to make the prostheses because it can be tinted to match the pigmentation of each individual.

A facial prosthesis is held in place by one of two methods:

• Adhesive
• Bone-integrated implants

The adhesive method is the same used to secure masks and camouflage make-up in the movies and requires the individual to apply a medical-grade adhesive to the back of the prosthesis to hold it in place. Certain situations such as high humidity, oily skin or profuse sweating can cause the prosthesis to come off at an inopportune moment and the possibility that this might happen can undermine the individual's confidence in the prosthesis. With this method, the prosthesis must removed and cleaned, along with the underlying skin, every evening.

The implant method is more secure for retaining a facial prosthesis. The use of bone-integrated implants, a process known as osseointegration, usually requires two minor surgeries. The first surgery is the implanting of little titanium fixtures (implants) into the bone and requires at least three months for the bone to grow around the implants to securely hold them in place. The second surgery, called an abutment, extends the implants above the skin surface by using an intermediate titanium extensions. The abutments can then be used to either hold a gold bar so that the prosthesis can be clipped into place or magnets can be used. Osseointegration method greatly enhances the retention of a prosthesis and enables the anaplastologist to achieve better esthetic results. This form of prosthesis also needs to be removed overnight and cleaned, along with the underlying skin, on a daily basis.

There are occasions when both surgeries can be performed in one procedure. Unfortunately, not every individual in need of a facial prosthesis is a candidate for osseointegration and therefore, treatment options should be discussed, at length, with an experienced craniofacial rehabilitation team.

A facial prosthesis degrades over time and loses some of its esthetic value. This is caused by several factors, such as pollution, body oils, and ultraviolet light, which slowly make it more yellow in color. Typically, a facial prosthesis needs to be remade approximately every two years.