At the Johns Hopkins Facial Prosthetics Clinic, Juan R. García, MA, Certified Clinical Anaplastologist provides patients with non-weight bearing custom-designed rehabilitative prostheses for the face, eye or body. These devices are used in the treatment of disfigurements caused by trauma, cancer, or developmental differences.
Patients and physicians may arrange for a free consult or referral by calling 410-955-8215.
The prostheses a clinical anaplastologist makes are non weight-bearing and are worn externally, on the skin surface to cover, protect, and modify disfigured or missing anatomy in the face, eye or body. These devices are not meant to be “perfect” or “totally indistinguishable.” Instead, they are “realistic enough” to allow the wearer to maintain social interaction while minimizing discomfort. The primary concern is to protect and maximally restore function through a safe and comfortable prosthesis.
Prostheses address several functional needs such as protecting underlying fragile tissues, closing off an open cavity, warming incoming air, and providing support for eyeglasses. Secondarily, the device should match the remaining anatomy as much as possible, knowing that there are limitations to reproducing living tissue through the use of artificial materials and a process that relies equally on clinical, artistic and technical skills. Other factors, such as secure retention and the ability of the patient to accept and care for the device over the long term, will also contribute to a successful outcome.
A prosthetic treatment plan is generally decided upon through a collaborative effort between the physician, clinical anaplastologist, and the patient. Once the patient has been medically cleared to proceed with treatment, a prosthesis can generally be made over several office visits.
The process involves the following steps: creating a casting of the affected area, sculpting a custom prosthesis out of wax, creating a mold of the sculpted form, casting the final prosthesis in silicone, and externally painting to more closely match a patient’s skin tones. Prostheses can be secured through the use of adhesives, tape, magnets or implantable screws to which a bar and clip or magnet system is attached. The chosen method of retention will affect the length and number of appointments as well as the time frame for delivery of the prosthesis.
The Clinical Anaplastologist
The professional that creates the prosthesis is known as a clinical anaplastologist. This is a non-physician provider with varied educational and training background. Our clinical anaplastologist, Mr. Juan García received his Master of Arts degree from the Johns Hopkins University School of Medicine in Medical & Biological Illustration. He since participated in several training and continuing educational opportunities to develop his skills in the discipline of anaplastology. He currently holds an Associate Professor appointment in the department and serves as the Clinic Director. Mr. García is a former president of the International Anaplastology Association (IAA) and continues to participate as an active member, providing many lectures and workshops over the years. Mr. García has also played an active role in the development of clinical standards in the field as a board member of the Board for Certification in Clinical Anaplastology (BCCA). He is a board Certified Clinical Anaplastologist (CCA).
The Johns Hopkins Facial Prosthetics/Anaplastology Clinic offers a Supervised Clinical Anaplastology Training Program for individuals interested in pursuing education in this field. Program requirements as well as information for applying to the program can be found by clicking the link above.
Individuals interested in learning more about the field are also encouraged to review the Education and Training information posted on the International Anaplastology Association (IAA) and the Candidate Handbook information posted on the Board for Certification in Clinical Anaplastology (BCCA).
Commonly Asked Questions
In our experience, there are certain questions patients will frequently ask:
- Prostheses are custom made for the individual. They are not “off the shelf” items. Several appointments will be needed to create a safe and effective prosthesis that is also realistic in appearance.
- Prostheses are considered durable medical equipment (DME) and are covered by most medical plans (including Medicare) under the DME rider portion of their policy. A Certificate of Medical Necessity is requested from the referring physician to establish the medical need.
- The patient will need to wait a period of time after surgery for healing to occur before treatment begins. It is preferable that all swelling subsides so the impression that is taken as the first step is accurate. Otherwise the final prosthesis will show noticeable gapping in previously swollen areas. The physician is consulted to determine when the patient is ready for prosthetic treatment.
- The expected lifetime of the device is usually 1-3 years for an adhesive retained prosthesis; whereas osseointegrated prostheses tend to last 3-5 years. Since these are separate from the body and made from artificial materials, prostheses can be lost, damaged, or discolored by smoke and UV light. Subsequent remakes can be made using molds which are kept on file for the patient.
- Retention of the prosthesis is one area that is of particular concern to the patient. Prostheses should be well retained to the tissues they cover. Prostheses are removed daily, at the end of the day. They are not permanently attached to the site. Various methods of retention with different strengths are available. These include: adhesive, attaching to glasses, tape and magnets, engaging anatomical undercuts, and osseointegrated implant fixtures (screws).
- The retention method is considered during the treatment planning process and is chosen in consultation with the physician and patient based on factors such as age, visual acuity, manual dexterity, sensitivity of skin, and past radiation treatment.
- Osseointegrated retention is considered state of the art. It is much less rigorous on the patient in that it does not require the patient to don and remove adhesive on a daily basis. The patient simply attaches their prosthesis using a magnet or clip system.
- Prosthetic restoration requires daily care and maintenance procedures. Prostheses are removed on a daily basis, and the skin, osseointegrated implant abutments and prosthesis are cleaned. If required, adhesive is applied and removed on a regular basis.
The kinds of prostheses made by our clinic are broadly categorized into Facial (including orbital, nasal, auricular, and other combinations in the face); Ocular (or eye prosthesis), and Somatic (e.g. Tracheostoma speech appliances), as well as Custom Medical Devices (including custom surgical guides and custom body implants).
All images © JHU, Juan Garcia, MA, Certified Clinical Anaplastologist
For more information or for referrals, contact us:
Juan R. García, Facial Prosthetics Clinic
Department of Art as Applied to Medicine
1830 E. Monument Street, Suite 7000, Baltimore, MD 21287
Call (410) 955-3213, Fax (410) 955-1085
or e-mail us at firstname.lastname@example.org to arrange a consult.