The art behind looking normal

By Ged Cann -
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Prostheses that technician Mike Williams has created. Photo / Ged Cann.
Prostheses that technician Mike Williams has created. Photo / Ged Cann.

Mike Williams spends his days working at Waikato Hospital being stared at by dozens of eyes and surrounded by myriad body parts.

Welcome to the strange world of maxillofacial prosthetics, where Mr Williams, a technician, creates everything from prosthetic noses to artificial eyes.

"Of all the defects you will see, 90 per cent are related to cancer. You have part of your face chopped out and you end up coming to see us," Mr Williams said.

"Sometimes it is due to accidents, but that doesn't happen very often. Then there are congenital abnormalities like cleft palates."

Work will often begin with a bio-model, which is taken from a CAT scan of a patient's skull. That is then 3D printed and can then be used as a model to create implants and prosthetics like titanium reconstruction plates to replace the jaw that are tailor-made for the recipient.

Mr Williams' work can range from creating realistic ears that connect in place by a titanium bar framework using gold clips or alternatively magnets to dentures called obturators which often replace half of the patient's missing upper jaw.

He is even able to produce nipples which taper perfectly to the skin for mastectomy patients.

Such a specialised service could be expected to take weeks, given the need to match everything from shape to skin tone and blemishes, but Mr Williams said the standard patient could be sorted out over the space of a few days.

The wait list for Mr William's service sits at around three months.

Technician Mike Williams. Photo / Ged Cann.
Technician Mike Williams. Photo / Ged Cann.

Every eye is matched for iris and sclera colour and even given tiny blood vessels from teased cotton to match the other eye.

"People say I'm a bit of an artist, and you have to use your artistic flare, if you like, to modify the state of something so it looks okay while accommodating the soft tissues underneath," Mr Williams said.

"You want to try and mirror as closely as possible what the other eye or ear looks like."

The process for making all prostheses is the same as an artist might use to cast a bronze.

"Instead of casting hot metal we are casting plastic and silicon, but the process is very similar. All the moulds are made out of what is basically plaster of paris."

The method of creating an eye is also a strange mix of archaic and revolutionary techniques, with the iris painted by hand with oil paints and rubber-based filler used to create the correct impression for the eye to sit in.

In days past Mr Williams said prosthetics were attached to spectacles, however nowadays he tends to use medical adhesive or preferably fixing components implanted in patients' bones.

These are made of titanium - the same as dental implants to retain teeth - which was necessary to avoid accidently creating an electric circuit where fluids are involved, such as in or around a patient's mouth as components attached to the implants might be made from other metals.

The average magnet used to retain a prosthesis that Mr Williams creates has 800 grams of retention, and some prostheses may have two or three magnets to ensure they stay put on the patient's face.

"Unless you really whack the ear it's not coming off," he said.

Mr Williams said in the past he had had three patients who had diamonds implanted in their fake eyes, and even had a young woman ask him to make her a paua shell iris.

According to Mr Williams the layman would be shocked at how often they come across someone with a prosthesis and don't even realise it.

"One lady lost an orbit and before the prosthesis she used to wear an eye pad and people used to open doors and watch out for her, but when we restored her eye and her appearance she had to get used to being normal again."

He said self-confidence and body image was what he was trying to restore.

"Everyone wants to just look normal and be ignored, unless you're one of those clowns on Geordie Shore."

He said a colleague who had done a PhD on the subject in New Zealand estimated there were 3000 people with artificial eyes.

The duration of a prosthetic depends on the motion of that part of the face, with ears lasting far longer than noses simply because of the movement.

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