I am one of 350 experts in the world that specialize in making prosthetics for people who have had parts of their face removed.

I don't have a question... I'm an ENT surgical technician who works with wounded warriors and I just want to thank you for the work you do... I've seen some of these guys come back from theatre with a face looking like ground hamburger, and the work that you and people like you undertake is uplifting. So, thank you for doing what you do.

It truly is my pleasure. While making these appliances, you spend time with people while sculpting them a new part, and getting to know them is the best part of this job.

This may not be something you know, but how accurate is the show Boardwalk Empire in presenting the prosthetic mask used by Richard Harrow (Jack Huston)?

So, even though I've only seen half of the first season before cancelling my HBO in protest of cable injustice (big mistake on my part), I have seen pictures, and it is fairly accurate.
They used to make prosthetics out of very thin pieces of tin or other metal that we meticulously painted. They would suspend these appliances from glasses or strings around the head. It's actually quite remarkable what they could do.

What is the most intensive replacement you've had to do? Thank you for doing this sort of thing, it really does help a lot of people.

Probably that last one, but here is another. There was a man who had many recurrences of cancer, he lost the roof of his mouth and also his eye. We made him an oral appliance to close the palate and also an eye appliance to cover the defect in his face. To keep the in better we attached the two (inside his head) with a magnet!

It's fun when you have a patient with a good sense of humor, this gentleman could lick his eyebrow by putting his tongue up through his palate and into his eye socket from below!

What was the most difficult palate case you dealt with?

What was the most unique or memorable reconstructive case you have worked on?

The most difficult palate cases are the kids who have had failed surgeries. With today's techniques, we can surgically close most cleft, but if a surgery fails sometimes you can't operate again, they are left with strange wounds, and they need to wear an appliance (like a retainer with a tail) to close off their palate. It's difficult to see kids struggle with those kinds of problems.

One of the most unique was a woman from another country who had agressive cancer and was not expected to live. Instead of a traditional appliance, they actually wired a denture into her facial bones as a temporary jaw until she passed away. Well, she was pretty tough and beat the cancer. She came to the US several YEARS later with this horrid, infected mess of a denture that caused destruction of her facial bones, so much so that pus was oozing out of her face (sorry to be graphic). We got the denture removed and made her a new appliance to eat and speak with. It was difficult beacuse when her tissues healed it was so scarred that she didn't have lips or and upper jaw. It's amazing to see how far someone can come.

As the brother of someone who was born with a midline defect that included a cleft lip/palate I just wanted to thank you for all the work that you do.

He's 14 now and looks completely normal, speaks perfectly, and is living a normal life.

Our executive director has a saying that others try to make normal people look/sound exceptional. We try to make exceptional people look and sound normal. I am so happy to hear that.

How did you get started?

Well, since my dad decided that I was not allowed to go to art school and my high school job was a dental assistant, I decided to become a dentist. I loved art and science and through dental school I learned about Maxillofacial Prosthetics, which for me is the most artistic thing dentistry had to offer. You get to sit with people and scult their face, and help them in the process!

Are any prosthetics ever kept customizable or do patients ever return to have things visually changed? Could you see your work ever expanding into a commercial cosmetic market? What are your thoughts on the possibility of people looking for parts of their face replaced by choice rather than as the result of an accident or such?

Hopefully this isn't a silly question, thanks for your time!

That's actually a really intersting question.
We will often make multiple prosthesis. For example, a woman's eye with and without makeup. Or a nose or ear for winter and one for summer if skin color differs in the sun. The pieces are both internally colored and also painted so we also do touch ups every once in a while as well.

The hassle of keeping these things on and their inability to move or function like your own parts will probably keep people from voluntarily opting for a prosthetic. However, I could definitely see prosthetic cheek or chin enhancers that glue on before make-up. Temporary plastic surgery!

"Could you make me a woman?" Edit: -Mrs. Doubtfire

I could probably make you woman parts:)

What was the most difficult thing you've had to make?

Once in residency there was a woman who had lost her entire face to an animal attack. She had one eye, a lower lip, and chin. The rest of her face had been skin grafted and was pretty amorphous. That was difficult and interesting to make because there was nothing normal surrounding the area to match the facial prosthesis to. I had never seen or made anythig that extensive. It was also interesting because she had looked somewhat like me before the accident, so we took an impression of my face as a starting point for her prosthesis.

After seeing prosthetic arms and hands made with a 3D printer, do you think facial prosthetics could be made that way? Are 3D printed prosthetics something we should invest or research more of?

Absolutely, they already have scanners that will scan the defect site and digitally construct prosthetics. It's wonderful because if the patient has a normal eye, ear, etc, the machine will scan it and reverse the image to make a prosthetic. The problem is that there really is a bit of artistry needed to make it look real, and I don't think the manufacturing process if perfected.
I am sure this is how we will do it in the future, but at this time the technology is too expensive to be eodely available for use.

This sounds super in nteresting. I have a bachelors degree in biomedical science. Please employee me. Pretty please.

Can you paint and tolerate mucous?

What's up with Michael Jackson?

Don't quote me, but there might have been some removable parts.

Could you make me a prostedic face that looked like the Terminator?

Yes.

Hello Andrea, is there any tips or advice for someone who is looking to get into this field or rather one close to it (I'm working my path to becoming a Maxillofacial & Oral Surgeon)?

Bravo! It's a long road, but don't stop. I would say that I learned the most from things that I really didn't want to do. Like volunteering for kids dental check ups (not that I really didn't want to, but sleeping in a Saturday is fun too) - you will meet people and learn things that will round out your skills so much more than your standard education. We were forced to scour of lab in residency and getting to know the technicians was invaluable beacuse we learned all kinds of tips and tricks from them. Of course, do well in your schoolwork, but it's the extra stuff that turns out to be interesting and will set you apart.

How are the prostetics held in place? Is there an art to designing a feature to match a persons real face?

Usually with medical grade adhesive.
In certain areas like the nose or ear, we can place implants (like a shorter version of a dental implant) that we can clip the prosthetics to. That is ideal and nice for patients because the prosthesis stays in place even when they sweat.

Is smile train a good charity? Do you get money from them?

They are definitely a good charity. They focus on children in other countries who need cleft surgeries, so we do not get funding from them. Some of our surgeons actually go on Smile Train missions.
Unfortunately, there are so many kids in this country who are underinsured and clinics like ours that exist to help them. We rely on donations from foundations, corporations, anyone who can help to cover our losses.
We also have a dental practice for non-cleft patients several days out of the week and the proceed from that go to serve our cleft kids. You can find out more at www.cleftclinic.org

You seem to work in a highly specialized field. Do most of your patients have to travel to see you? If so, does this put any address stress on doing your job?

Some patients do travel a few hours. Hopefully most feel that it's worth it, but for those who need to come for multiple visits, it can me hard to find time. If we are using your eye as a reference for an eye prothesis and you've just traveled four hours at the crack of dawn, it's likely your prosthesis is going to look sleepy.

Our cleft kids and their families usually come at least twice per year for team visits with all of our specialists, and we always try to give everyone our best when they've traveled. Even when they haven't.

Are the people in your field familiar with the use of 3D printing to lower the cost of such devices?

Yes, I think that is the way things are heading. We have scanners and printers that do make appliances, but the machinery involved isn't widely available to places like ours yet.

Hopefully it becomes more widespread and financially accessible to your field.

Totally agree, we could even make different ones as they heal, instead of having to wait for months of healing in order to have stable tissue for a prosthesis.

Whats the most often thing you are asked to do ( except the cleft lip you mentioned)?

I will most often make obturator appliances, which is like a denture or retainer for patients who have had parts of their jaw, palate, and sinus removed. It covers the opening into their nose so that they sound normal when they speak and don't get food and drinks up into the nose or sinus when they eat.

Could I get a entirely new face, eventhough my current one is perfectly good?

Yes, but insurance won't cover it:)

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He did indeed. It made for a pretty awesome show though, so I don't think I'd change a thing.

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I'm not what the fastest route to bioengineering would be, but with the background in physiology, mechanical engineering might be most applicable. I would also look into computer aided design because so much of medicine is going that way. Have you ever considered visiting a VA hospital? They usually have an amazing staff who works with prosthetics and (unfortunately) are busy. That might be a place to start.

Hi AndreaLSmith, do you have any proof?

I should be on our website, www.cleftclinic.org. I also tried to post a picture of me with one of our eye appliances but failed miserably. Tech stuff isn't my strong suit. I'll try again.

If you reconstructed an eye, would it work?

It would not. Usually the people I see have had their eye, the bones around it, and the nerve removed, so not much works. Sometimes the muscles can be preserved and a false else that is inserted can move like a normal eye even though there is no vision.