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Originally published Sunday, November 27, 2005 at 12:00 AM

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Prosthesis professionals work with science, art

These eyelids don't blink. And the ears don't twitch, blush or tan. But what they will do is priceless. "The prosthesis can add to the wearer's...

The Dallas Morning News

DALLAS — These eyelids don't blink. And the ears don't twitch, blush or tan.

But what they will do is priceless.

"The prosthesis can add to the wearer's confidence and ease anxiety in social situations or everyday encounters like walking down the street, shopping or riding public transit," said Sharon Haggerty, executive director of the American Anaplastology Association, which promotes the restoration of human anatomy by artificial means.

Founded in 1980, the group unites an array of specialists providing prostheses for patients with facial and bodily disfigurements due to cancer, trauma or birth defects.

In a profession integrating science with art, results rely largely on the skills of the anaplastologist and the supporting rehabilitation team. With the emergence of new materials and technology, so much more has become possible.

"The last 5 percent of what makes a prosthesis truly convincing and usable requires an artist," said Greg Gion, 48, certified clinical anaplastologist and founder of Medical Art Prosthetics in Dallas.

Skills needed


American Anaplastology Association:

American Academy of Maxillofacial Prosthetics:

Thinking about a career in anaplastology? There's a lot to learn.

Aspiring practitioners need to be computer savvy in 3-D technology. They should commit to a master's program. Most important, they have to be passionate about details, Gion said.

Positions exist mainly on rehabilitation teams at larger hospitals, cancer centers or universities.

Experienced anaplastologists also may develop private practices. Here, too, they're part of a team of surgeons, audiologists, therapists, laboratory technicians and prosthodontists — specialists in tooth restoration.

"Anaplastologists come from a plethora of educational and clinical backgrounds, and utilize skills in medical art, medicine, dentistry, dental technology and engineering. My background stems from medical illustration," said Suzanne Verma, 28, an anaplastologist in the Center for Maxillofacial (jaws and face) Prosthetics at Baylor College of Dentistry in Dallas.

She received a master's degree in biomedical visualization, with an emphasis in facial prosthetics, from the University of Illinois Medical Center at Chicago.

It's one of the few anaplastology-oriented programs.

A two-year trainee residency for maxillofacial prosthetic technicians is offered at Bronx Veterans Affairs Medical Center, affiliated with Columbia University School of Dental and Oral Surgery in New York.

These positions prepare trainees to assist maxillofacial prosthodontists.

Several university- and hospital-based clinics have closed in the last decade, Haggerty said. One reason is that the medical community has been slow to refer patients for these services.

"There is a need for training programs, but there also has to be a place for graduates to practice," she said.

Salaries average around $35,000 to $55,000 annually, estimated Haggerty, director of Custom Prosthetic in Seattle. Ocularists (specialists in eye prostheses) and prosthodontists usually earn more.

"If earning potential is important, don't apply. If you are weighing this against accounting, finance, law ... you probably won't be happy," Gion cautioned.

"My business generates about $230K a year and is still growing, but that's after 20 years. This is somewhat unusual for just doing facial prostheses. There are very few of us who have independent practices apart from another professional or related services."

Creativity helps

For those who are dedicated, this field offers an immense outlet for creativity while delivering competent and compassionate care, Haggerty said.

Not only does a prosthesis serve an aesthetic purpose, but it also protects sensitive structures from the elements.

Today's anaplastologists have a wealth of resources to accomplish their work. Since silicone debuted in the 1960s, it revolutionized the industry.

Many patients cast aside prostheses made of latex rubber, cellulose, acrylic or polyvinyl carbonate. The new material is better tolerated, variably soft and translucent — much like skin.

"Silicone is colored to match the patient's various skin tones, including small details such as blood vessels and freckles," said Baylor College of Dentistry's Verma. "Each prosthesis is unique in its design, makeup and method of retention."

Bone-anchored implants initially were used in dental applications but later adapted for artificial ears and other devices. These titanium implants are surgically placed in the patient's skull and eventually employed to retain an external prosthesis via sophisticated clips or magnets, Haggerty explained.

The latest innovations in computer technology save time during rehabilitation and facilitate accuracy.

Using data from a CT scan, an anaplastologist can create a customized implant from a computer model without performing invasive procedures on the patient.

"The custom-fabricated implant will fit the site, in most cases, like a piece of a puzzle," Haggerty said.

But there are limitations that both patient and anaplastologist must accept.

"A well-designed and fabricated prosthesis may go unnoticed but may be detectable under closer observation," she said. "It is not designed to fool loved ones or those who intimately know the wearer."

Beyond that, "even with proper care, the prosthesis will have a limited life span, may fade, discolor or tear and will need periodic replacement."

Job titles

Many types of prostheses fall under the umbrella of anaplastology, including artificial ears, eyes, noses, fingers and hands. Different specialists are involved:

• Anaplastologist — Makes prostheses for the face and body.

• Maxillofacial prosthetist and technologist — Creates prostheses for the face. It's the British equivalent of an anaplastologist.

• Maxillofacial prosthodontist — A dental professional specializing in prostheses for the face and mouth.

• Prosthotist/orthotist — Designs limb prostheses — hands, arms, legs and feet.

• Dental technician — Focuses on techniques and materials for dental and other prostheses.

• Ocularist — Constructs eye (ocular) prostheses. Ocularists have additional specialized training.

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