Frequently Asked Questions

What is a Prosthesis?

A prosthesis is an artificial substitute for a missing, disfigured, or malformed part of the face or body. Each prosthesis is custom made for the individual patient. Generally speaking, the different kinds of prostheses made by members of the IAA include: facial, somato (body), and ocular (eye) prostheses.

Prosthetic treatment offers an alternative when surgical reconstruction cannot be achieved or may be preferred by the patient. Prosthetic treatment offers various advantages and disadvantages compared to surgical reconstruction. Treatment options should be thoroughly discussed with a medical professional. Members of the IAA can assist by discussing a patient’s prosthetic needs, showing the patient examples of actual prostheses, discussing the process involved in producing the device, and providing photographs of previous cases for illustration.

The desired goal of a prosthesis is to restore form and function. A prosthesis helps to protect exposed delicate tissues, covers exposed cavities, may provide support for eyeglasses or hearing aids, and restores appearance. A prosthesis should replicate missing anatomy as closely as possible resulting in a natural and lifelike appearance. A well-made prosthesis can facilitate the return of an individual to most of their normal activities and eliminate the need for bandages and eye patches. It can help to restore self-confidence and ease the anxiety one might experience in a public setting. Because the prosthesis is not living tissue, there are some obvious limitations; the prosthesis may not restore normal movement, does not blush or tan and must be removed for cleaning. Even a well-made prosthesis may be detectable under close observation.

A prosthesis can address physical rehabilitation, but some patients may also require psychological counseling or spiritual direction. An IAA member can refer prosthetic patients to seek this type of treatment through their physician, a team member counselor, or an appropriate healthcare provider.

When provided by a non-physician, prosthetic devices are considered durable medical equipment, and as such are usually prescribed by a physician and covered by insurance companies when medically necessary.

How is a Prosthesis Made?

The process of making prostheses is a synthesis of art and science. The results are therefore dependent on the artistic, clinical, and technical skills of the professional. A well-made facial prosthesis serves to restore form whenever possible. Anatomical landmarks, facial proportion, symmetry, direction of skin folds, tissue texture, and coloration of skin are all taken into account to create a convincing, life-like appearance.

The process of designing and fabricating a prosthesis requires multiple office visits, which may be lengthy, as well as numerous hours of laboratory work. The following steps will be necessary:

Additional steps may be required for some types of prostheses.

How is a Prosthesis Kept On?

Each patient is evaluated individually to determine the best method of retaining his or her prosthesis comfortably and securely. Medical history, dexterity, and extent of tissue loss are all important factors that must be considered. The most common retention methods include:

Adhesive retention involves the application of medical grade products to the back side of a prosthesis. Adhesive can hold a prosthesis on throughout the day. Factors such as humidity, oily skin, or profuse sweating, can compromise the adhesive retention of the prosthesis. There are various grades of adhesive and other skin care products that can be used to address this problem. The clinical anaplastologist can assist in selecting a proper combination of products to address the individual’s particular need.

In anatomical or self retention, the prosthesis stays in place on its own. Not all cases will lend themselves to this method. The back surface of the prosthesis is shaped to engage the remaining tissue. Another method to secure a prosthesis, is known as mechanical retention. This strategy can be used on its own or combined with other methods. It can involve attaching the prosthesis to a pair of glasses. Alternately, the prosthesis can be attached via magnets to an obturator (an intraoral prosthesis covering an open cavity). Attaching the prosthesis to bone anchored implants is also considered mechanical retention.

Craniofacial bone-anchored implants are considered “state of the art” in retention technology. Implants allow ease of applying the prosthesis, improved security over skin adhesives and allow for improved aesthetics. This process may require one or two surgical procedures performed by a surgeon on an outpatient basis. The first surgery consists of implanting small titanium screws into the bone at the site of the affected area. The implants are left alone for a period of at least three months while the bone grows around them to hold them in place. This process is known as osseointegration. A small titanium connecting piece called an abutment, is then used to extend the implant site above the skin surface. A gold bar can then be attached to the abutments to allow the prosthesis to clip in place. Alternately, magnets can be secured to the abutment for attachment of the prosthesis. Unfortunately, not every individual in need of a facial prosthesis is a candidate for osseointegration. Whether this option is appropriate for your case should be thoroughly discussed with a qualified physician.

Finally, some special types of somato prostheses can be implanted under the skin. They can be made of silicone or acrylic plastic. These prostheses are designed in close collaboration with a medical professional who ultimately performs the surgical procedure. Some examples include chest augmentation, nasal-septal, calf, and cranial subdermal implant prostheses.

The retention method chosen will be based on considerations of occupation, lifestyle, ability to handle the maintenance routines, and availability of assistance when necessary. The way in which the prosthesis is secured may be as unique as the condition being treated and is carefully planned by the clinical anaplastologist after a discussion with the patient. It is important to note that in all methods (except for surgically implanted body prostheses) the prosthesis is meant to be removed at night. This allows for the skin under the prosthesis to breath and is part of a daily cleaning maintenance routine the patient incorporates into their schedule.

How Long Does a Prosthesis Last?

Prostheses degrade over time due to several factors. Because of this, they are remade approximately every two years or when deemed unusable by your physician. Thin edges of prostheses can tear, color can fade over time, smoke can discolor the silicone material, and eyelashes can come out. However, prostheses last longer if they are well cared for and maintained. Implant retained prostheses may have an extended useful life because of the elimination of adhesive products.

Once the molds are created for an individual, subsequent prostheses can be made without the need of additional impression or sculpting work if the tissues in the reconstructed area have not changed in the interim. When the affected area changes in shape or as the individual ages, a new impression or sculpting may be required to achieve continued functional and aesthetic results. Long term prosthetic treatment can involve periodic visits to an anaplastologist, physician, or another health care specialist, who will evaluate the condition of the prosthesis and check for concerns associated with the underlying skin.  A prosthetic device should be passively comfortable to the wearer.  If a patient experiences a rash, sore spot, skin inflammation or swelling, prosthetic use should be discontinued and the provider should be called and the physician consulted.

Who Makes Prostheses?

Makers of prosthetic devices have various educational backgrounds and different professional titles. Practitioners can specialize in several areas within the full scope of prosthetic restoration services based upon their unique education and training. Below is a listing of different specialists and definitions for each:

Anaplastologists and other specialists are either certified or licensed through corresponding professional organizations or states of residence. Prosthetic specialists have specific areas of training. All providers should respect the boundaries within the scope of their expertise. As a patient, it is prudent to discuss with your provider their area of specialization and assess what types of prostheses they are capable and qualified to provide.