Prosthetic is a general term referring to an artificial or man-made part of the body. The term “Prosthetics” is often associated with the field of prosthetic limbs (artificial arms and legs). However; dentures, plastic eyes, mastectomy forms, wigs and artificial hip joints are all prostheses too. Each kind of prosthesis is generally created by a different type of practitioner. Anaplastology (coined by Dr.Walter Spohn circa 1980) is a newer term also referring to the art and science of restoring the body with prosthetic materials. In contrast to prosthetic dentistry, ocularistry or limb prosthetics, anaplastology is highly diverse and adaptive to patient conditions involving many parts of the body. Therefore, its practitioners are highly diverse in their education, training and talent. Today’s anaplastologists often provide prosthetic restorations of external soft tissue structures of the face, hand, foot, breast or other area of the body. Anaplastologists often team with other prosthetic specialists like prosthodontists or physicians to prepare custom prosthetic devices, some for surgical implantation in the body.
We recommend that you always have a personal interview with a dedicated facial anaplastologist and view a comprehensive portfolio of full-face or close-up high quality photographs of the clinical results before deciding to begin treatment with the anaplastologist. Good photos will provide some reference for how closely the colors and textures will match and blend in with your skin. Photographs go a long way in building your confidence in your anaplastologist’s ability to instill a life-like quality in your prosthesis that faithfully reflects your individual characteristics. A comprehensive portfolio of cases will indicate the breadth and depth of the anaplastologist’s overall clinical experience and versatility specifically in facial restoration. Photos should include examples of various designs and attachment methods to substantiate knowledge of and willingness to employ the most effective and appropriate methods for you. Often the most technically demanding and time consuming methods for us to devise are the methods that ultimately make life with the prosthesis easiest for you – and we enthusiastically explain the best methods for you.
We encourage candidates for any facial prosthesis to look beyond subjective claims about “aesthetic beauty”, “invisible margins” or other relative terms. Also the stature of medical or dental institutions might be indicative of sophistocated technologies and comprehensive care, but not necessarily the quality or effectiveness of the final facial/somatic prosthetic results they deliver. For example, we find that some scanning and prototyping machines are impressive tools, and we sometimes use them to streamline and enhance our processes and results for our patients. However, they still are only tools. The accuracy and aesthetic quality of the final visual result; just the way the prosthesis looks seated on the face remains the most unscientific, unpredictable and inconsistently delivered attribute of facial prostheses . The convincing life-like quality of your restoration will be solely determined by the visual acuity, the artistic skill and the will of the practitioner you have selected. Please review the entirety of our website as an educational first step in your restoration process.
Every prosthesis will be delivered with full verbal and written instructions as well as a thorough demonstration in how it is used. Check-ups are very helpful to assure maximum comfort with and benefit from the prosthesis. Any prosthetic device will require repair/replacement at some point, but need of these services will depend on the type of prosthesis and individual use and wear habits. Since we treat silicone as an art media constantly we have developed the capability to perform some repair/replacement services without requiring your presence at our facilities. Our goal is to keep patients happy with their prosthesis, and hundreds still return for service.
Consultation / Evaluation:
We meet with you, examine the involved area and discuss how we can help. All options are explained in detail. If you wish to see photos of others wearing the same type of prosthesis we will select appropriate cases from our portfolio of hundreds of prosthetic results. You can also handle sample prostheses that fit onto demonstration models. We answer all of your questions as clearly and completely as possible, and recommend other specialists when their services might enhance your restorative outcome. Prostheses that attach to bone-anchored implants are a wonderful option for many, but they do require a surgery. If this implant-retained type of prosthesis is an option for you we will begin coordinating as a team: you, your MAP anaplastologist and your doctor and/or surgeons we can recommend. Finally, we will have customized written materials for you to take home and review at your convenience.
Impression for the Surgical Guide:
We use a soft impression material to smooth over and around the involved areas to accurately record the important shapes that will result in a perfect fit of the prosthesis. Our material has a consistency similar to gel toothpaste, but after it sets in a few minutes it still remains flexible and lifts easily from the skin capturing and recording all the important details. The technique is similar to an orthodontist taking an impression of the teeth, or an audiologist making an ear mold for a hearing aid: simple, quick, and painless. From the impressions we are then able to produce actual casts of your contours that we will build upon.
Sculpting for the Surgical Guide:
The surgeon needs to know where the implants should ideally be positioned in your bone so that they will stabilize your prosthesis and also remain hidden beneath it. An excellent way for us to help the surgeon is to provide him/her with an actual silicone prosthesis that is already accurate in size, shape and the way in rests in its proper position on you. To do this, we use the casts we made from you and our scanning/sculpting procedures to prepare a wax prototype. After we verify the accuracy of the wax prototype it is molded and cast into the silicone surgical guide. Guide holes or slots are cut into the guide to indicate to the surgeon the ideal positions for the implants. It is then delivered to the operating room prior to your surgery.
Date of Surgery:
In the operating room the surgeon positions the guide (also referred to as “positioner” or “template”) and marks where the implants should be placed. The implant fixtures are then firmly anchored into the bone. Holes are then made in the skin over the implants and small posts about ½” in length are then snuggly screwed into the implant fixtures. These posts are called healing abutments and they will remain in place only for the healing/osseointegration period. The implant placement procedure is often just a day-surgery and the patient is later allowed to go home that same day.
Three to Six Months After Surgery:
At some point during this time frame your surgeon will determine that your implant fixtures have fully integrated with the bone and that your skin has healed properly around the healing abutments. Your MAP anaplastologist will then determine the proper abutments to replace your healing abutments with. In doing this we take a few measurements and record the best attachment components and permanent abutments, and then special order them from the implant company.
Abutment Placement & Impression Taking:
Healing abutments are replaced with the final prosthetic abutments and attaching components. Then an impression is taken of the abutments and surrounding contours.
SCULPTING/DESIGNING:
You have plenty of opportunity to finally see your prosthesis taking shape as we painstakingly sculpt and check the fit of the wax prototype right on you. Our experience guides most of our critical design decisions such as how the prosthesis will transition with your skin. However, we appreciate the emotional aspect of this process and invite relaxed open discussions about personal preferences such as nasal shape, eye expression, etc. You will have plenty of opportunity to view the model in place and discuss nuances you would like to see. Our approach as artists and our emphasis on anaplastology are tailored to make this a restoring and positive experience for you. That’s why we sometimes decide to have an additional session either later that day or another day to take a fresh objective look at our progress, to double check the fit and margin transitions and to make all final refinements — unhurried.
COLOR MATCHING:
Your “skin color” is the result of an amazingly complex combination of pigmentation, vascularity and other physiological factors that you share with no other person. As MAP anaplastologists we use our clinical training and digital photography to record your basic skin tone and characterization. However, we rely most heavily on our visual acuity as artists to see, interpret and record much of the color defining detail that is unique to the area on your body being restored. The methods we use range from photographing skin character reference swatches to painterly application of silicone color into the fabrication mold. Color matching is sometimes combined with the sculpting session or it is done at the time the silicone is actually packed into the mold for polymerization (fabrication).
EXTERNAL TINTING:
After the silicone is polymerized and the prosthesis is removed from the mold it is trimmed, placed on our patient and meticulously hand tinted to add or enhance the tiny blood vessels, freckles and other simulations that make the prosthesis look just like the adjacent skin. The tinting session ranges from ½ hour to 1 and ½ hours, typically. Then the prosthesis is removed once more for its final preparations prior to delivery.
DELIVERY and INSTRUCTIONS:
Your prosthesis and its proper use will be carefully demonstrated in front of you. All the steps will be reviewed with you including; cleaning the prosthesis, cleaning your skin, placement of the prosthesis, removal of the prosthesis and proper storing of the prosthesis when not in use. You also will go home with full written instructions to refer to and our phone numbers in case you have any questions.
Sample timeline for receiving your implant-retained prosthesis:
Initial Visit:
- Day 1; Morning; Consultation/Evaluation/Impressions
Afternoon; Surgeon Consult/Team Planning - Day 2: Morning; Sculpting for Surgical Guide
…surgery scheduled…implants placed by surgeon…3-6 month osseointegration period…
Final Visit:
- Day 1: Morning; Abutments Ordered
- Day 2: Morning; Abutments Placed/Impressions
Afternoon; Sculpting - Day 3: Morning; Final Sculpting/Color Matching
- Day 4: Morning; Extrinsic Tinting
Afternoon; Delivery and Instructions
CONSULTATION/EVALUATION:
We meet with you, examine the involved area and discuss how we can help. All options are explained in detail and if you wish we will gladly show you demonstration models and similar case presentations. We answer all of your questions as clearly and completely as possible, and recommend other specialists when their services might enhance your restorative outcome. We can also provide customized written materials for you to take home and review at your convenience.
IMPRESSION TAKING:
We use a soft impression material to smooth over and around the involved areas to accurately record the important shapes that will result in a perfect fit of the prosthesis. Our material has a consistency similar to gel toothpaste, but after it sets in a few minutes it still remains flexible and lifts easily from the skin capturing and recording all the important details. The technique is similar to an orthodontist taking an impression of the teeth, or an audiologist making an ear mold for a hearing aid.
SCULPTING/DESIGNING:
You have plenty of opportunity to see your prosthesis taking shape as we painstakingly sculpt and check the fit of the wax prototype right on you. Our experience guides most of our critical design decisions about how the prosthesis will attach and fit with your skin. However, we appreciate the emotional aspect of this process and invite relaxed open discussions about personal preferences such as nasal shape, eye expression, etc. You will have plenty of opportunity to view the model in place and discuss nuances you would like to see. Our approach as artists and our emphasis on anaplastology are tailored to make this a restoring and positive experience for you. That’s why we sometimes decide to have an additional session either later that day or another day to take a fresh objective look at our progress, to double check the fit and margin transitions and to make all final refinements — unhurried.
COLOR MATCHING:
Your “skin color” is the result of an amazingly complex combination of pigmentation, vascularity and other physiological factors that you share with no other person. As MAP anaplastologists we use our clinical training and digital photography to record your basic skin tone and characterization. However, we rely most heavily on our visual acuity as artists to see, interpret and record much of the color defining detail that is unique to the area on your body being restored. The methods we use range from the photographing of skin character reference swatches to the painterly application of silicone color into the fabrication mold. Color matching is sometimes combined with the sculpting session or it is done at the time the silicone is actually packed into the mold for polymerization (fabrication).
EXTERNAL TINTING:
After the silicone is polymerized and the prosthesis is removed from the mold it is trimmed, placed into position on you and meticulously hand tinted including the tiny blood vessels, freckles and other simulations that make the prosthesis look just like the adjacent skin. The tinting session ranges from ½ hour to 1 and ½ hours, typically. Then the prosthesis is removed once more for its final preparations prior to delivery.
DELIVERY and INSTRUCTIONS:
Your prosthesis and its proper use will be carefully demonstrated in front of you. All the steps will be reviewed with you including; cleaning the prosthesis, cleaning your skin, application of adhesive or other attachment mechanisms, placement of the prosthesis, removal of the prosthesis and proper storing of the prosthesis when not in use. You also will go home with full written instructions to refer to and our phone numbers in case you have any questions.
Sample timelines for receiving your non-implant retained prosthesis:
Standard Timeline (Good for local or commuting patients; 0 overnight stays):
- Visit 1: Consultation/Evaluation/Impressions
- Visit 2: Sculpting/Final Sculpting/Color Matching
- Visit 3: Extrinsic Tinting
- Visit 4: Delivery and Instructions
Intensive Consecutive Day Plan (Ideal for out-of-town patients; requires 2-4 nights):
- Day 1: Morning; Consultation/Evaluation/Impressions
Afternoon; Sculpting - Day 2: Morning; Final Sculpting/Color Matching
- Day 3: Morning; Extrinsic Tinting
Afternoon; Delivery and Instructions
Combination Plan (Maximizes progress with just 1 or 2 overnight stay(s)):
- Visit 1: Day 1; Morning; Consultation/Evaluation/Impressions
Afternoon; Sculpting
Day 2; Morning; Final Sculpting/Color Matching - Visit 2: Day 1; Morning; Extrinsic Tinting
Afternoon; Delivery and Instructions
Day 2; Morning; (optional)
Technological advances in the fields of medicine and prosthetics have captured the imagination of the public, and many seeking prosthetics might think that the most technology laden institutions or clinics must be producing the most advanced results and the most successful outcomes in the delivery of any prosthetic services.
Based on over 30 years of specialization we would caution anyone from making this assumption.
There are several items that can actually enhance your success with your unique prosthesis. Whether you need an eye, nose, ear or other facial prosthesis please bring any or all of these items with you to your first appointment:
- preferred hair bands/clips/small clippers or hair trimmers (they might help us manage hair)
- eyeglasses; old or new, broken or not (they help us visualize design and plan margins or attachments)
- make-ups; liquid, powder, concealer, mascara, eyebrow pencils, sponges, etc.
- skin tapes, gauze bandages, skin adhesives or dressings that you use
- any previous ocular or silicone prostheses from other providers
- any dentures, hairpieces or other appliances you use
- photos of you before and after surgery (prints or email)
- CT scans of your head before and/or after your surgery (we can develop 3D printed prototypes from digital data that in some cases enhances workflow and accuracy)
Feel free to contact us if you have any questions.
Yes. Literature in the field of anaplastology is rare, so please download and print these handouts for your future reference.
Download “All of Medical Art Prosthetics Info Sheets” MAP-All-Prosthetics-v2022.pdf – 446.64 KB