While prosthetics can transform an actor into a sci-fi creature, it makes looking into the mirror that much easier for people who are disfigured.
To his left on the countertop are a dozen brushes and tiny lumps of acrylic and oil paint. To his right are a silicone gun, an oven and rows of prosthetic eyes, noses and ears in various stages of completion.
Blending art with science at a laboratory attached to the School of Dental Sciences, Universiti Sains Malaysia, in Kubang Kerian, Kelantan, dental technologist Abdullah Hamat crafts medical-grade replicas of eyes, noses, ears and dental pieces to make clients scarred by bouts of cancer, a birth defect or injury cosmetically whole again.
Abdullah, 53, is one of the three maxillofacial technologists at Hospital Universiti Sains Malaysia (HUSM).
Abdullah Hamat sculpts facial prostheses. Having 20 over years of experience in dental and 15 years in maxillofacial work, he has not only a steady hand and a grasp of anatomy, but also an eye for colour.
“After surgeons have done what they can to save the patients, we do what we can to make them look whole again.”
Eye-eye, sir
Sara Fikri, 29, a teacher at a school for special children, lost one eye to retinoblastoma cancer, a rapidly growing tumour on the retina. She had surgery to remove the cancer to prevent it from migrating to her brain cavity. At the recommendation of her ophthalmologist, she came to HUSM to have a prosthetic eye fitted.
“It was really traumatic soon after my surgery. I was in total shock when I discovered that nothing could be done to restore my eyesight,” she recalls.
Adjusting to eye loss, Sara admits, was not easy, but while many people might despair over the loss of an eye, she has learned to accept a prosthesis as part of her body.
“My family told me they wanted me to have every opportunity in life and if, by having an artificial eye I would be judged on my abilities and not my disabilities, I accept it.
A silicone nose “It is part of my daily routine now: shower, brush teeth, pop in eye. Somehow having a false eye makes me feel less vulnerable and reassured that my identity is not determined by my disability.
“After I had the eye replaced, very few people realise that it is a prosthesis,” she says.
“If I don’t tell them, they don’t know. Those who have just learned that one eye is a prosthesis will ask: ‘Really? Which one? The false eye doesn’t look too different from the working one’.
“Even I can’t tell which eye I made sometimes,” he says. “While an artificial eye can’t move the way a real eye does, and the size of the pupil does not change, there is usually nothing in the fit or the colour to give it away. It is practically indistinguishable.”
Prosthetic eyes have come a long way. Today they are made with more artistry than ever before.
“Because everyone is just a little bit different in the size and shape of their eyes and eye sockets, mass produced eyes, when placed in the socket, could just stare in the same direction all day,” he points out.
“The colours are not blended and it looks lifeless. Even for people with dark eyes there are many subtleties. Simply painting a brown or black circle with a black pupil in the middle will not do justice to the colour of a person’s eye and will look fake and unnatural,” Abdullah points out.
“Shaping an eye is similar to making dentures and involves the same materials and similar shaping and sculpting techniques,” he says.
“First, an impression of the eye socket is taken for a proper fit. This is a painless process that involves filling a syringe with silicone and packing it into the eye socket. Once the silicone is hardened, is it removed from the eye. From the mould, the artificial eye is made using sclera (white plastic). Children as young as eight go through this process without shedding a tear,” explains Abdullah.
When the sclera sets, it bears a precise image of the contours of the socket.
“An artificial eye is made to fit so that it will stay in place until the wearer takes it out,” he says.
At a glance, it resembles a shiny white shell, and is concave like a contact lens.
Then the real craftsmanship begins. Like an artist restoring a canvas, Abdullah meticulously hand-paints it to look like the real eye.
“We build the effect up in layers, gradually adding colour and texture, until we have close to a perfect match,” he says.
The white of the eye isn’t completely white in most people. It is slightly shaded and there are tiny blood vessels that can often be seen. An eye that is too white and doesn’t have any irregularities appears more doll-like. The blood vessels are too small to paint so we use red silk fibre to simulate it.”
A prosthetic eye will generally take five appointments, typically taking place over five to six weeks. Additional appointments may be required to achieve the optimum fit and colour match.
Blending art and science for a patient. The end results appear real enough to be almost eerie when seen on a counter top. The surface has a life-like reflection and gives an illusion of depth.
“The moistness of the socket allows the false eyes to move with the head. They are so light and comfortable that the patient forgets he’s wearing it,” says Abdullah.
Because of natural changes in eye-socket structure, the wearer of an artificial eye normally has to be fitted for a new prosthesis every three years for children and every five years for adults.
“The prosthesis will need to be replaced because of wear and tear and to keep up with the natural ear, which will continue to change with age,” he says.
Artificial eyes, according to Abdullah, are relatively low-maintenance.
“Home cleaning with water daily is sufficient to remove build up of the eye’s natural secretions and other irritants.”
When patients come for the final fitting, Abdullah will sit them down with a mirror and get them to try on the prosthesis to see whether it is a snug fit.
“If it doesn’t sit right, it comes out for further trimming,” he says.
New patients are taught how to put on and remove the prosthesis. Removing the artificial eye was difficult in the beginning for Sara but it is now second nature for her.
“I pull down the lower lid and look upward. The eye will slide out over the lower lid. To pop it back in, I just hold the eye between the thumb and forefinger and with the other hand, lift the upper eyelid. Then, I gently slide the top of the eye under the upper eyelid and hold it in place while I pull down the lower eyelid with the other hand so that it slips over the bottom of the eye, holding it in place,” she smiles.
An ear for an ear
Like any eight-year-old, Ahmad Danial Othman follows a routine to get ready for a day of school. He showers, combs his hair and has breakfast. Then, before he leaves, he hooks on his right ear.
As a toddler, Ahmad Danial lived with just a small flap of flesh and no hole where the ear canal should be. His left ear is real but his right one is made of silicone. When the prosthesis is attached, it’s difficult to tell it’s fake.
A prosthetic ear for Ahmad Danial Othman Although he may hear “supper” instead of “rubber” when someone speaks to him, Ahmad Danial no longer has to explain his appearance to his friends. He no longer has to subconsciously hide his missing ear from public view.
“Reconstructive surgery is not an option for Ahmad Danial as he is a growing child and the ear will remain child-size. A silicone prosthesis makes more sense,” says his father, school teacher Othman Mat Zin, 44.
“The prosthesis is clipped onto small titanium screws that have been surgically embedded into the skull by surgeons,” Abdullah explains.
The process of making an ear involves sculpting wax to create a prototype of the prosthesis. When the technologist is happy with the wax model, silicone is poured into the mould. Then, it is baked in an oven for a few hours before the second stage of the artistry comes into focus — hand-painting the details.
“Until recently, the base colour of the silicone was limited to very light colours which doesn’t suit Asian skin tones. Now, the silicone is available in three shades that match yellow and brown skin tones.
But as a child with a colouring book knows, a skin-tone colour pencil does not exist. Abdullah adds red, pink and green to add to the illusion of life and to simulate tiny blood vessels and imperfections.
“We created a mirror image of Ahmad Danial’s left ear, matching every shade of the natural ear,” he says.
“It takes only a few seconds for him to put on his ear in the morning and to remove it when he takes a shower or go to bed. It doesn’t fall off,” says Othman.
“The flesh-coloured silicone prosthesis looks almost identical to Ahmad Danial’s natural ear, right down to the blood vessels.”
Invisibility, however, comes at a price.
“The prosthetic ear set us back about RM10,000,” he says. Replacement parts don’t come cheap either.
“The hook on the prosthetic ear broke once and it cost me RM100 to replace it. I didn’t want to fork out that much money every time, so I went to a goldsmith and had a clip made from suasa (a mix of silver and gold) instead. I got three clips for less than RM100. Suasa is durable and I haven’t had to replace the clip since.”
Another happy client who can attest to Abdullah’s artistic skill is Ahmad Sazali Bujang, 42, a carpenter who got a prosthetic nose to replace the one he lost in a car accident.
A pair of plastic framed spectacles are attached to his nose and it looks just like the kind you would find in a party pack. Ahmad recalls his experience dealing with a missing nose.
“While no one comes out and says anything to me, it’s easy to read the discomfort on their faces. They look, then quickly look away,
“With a prosthetic nose, many people say they never would have known it wasn’t my real nose if I hadn’t told them,” he says proudly. “My family, especially, was amazed upon first seeing it.”
Prosthetic noses, says Abdullah, are modelled from the patient’s old photographs. When asked whether he would entertain requests for a nose that could rival Nicole Kidman’s, Abdullah laughs, “Yes, we do oblige when a patient requests that we sculpt an improved version of their nose.”
HUSM, says Abdullah, is constantly experimenting with new innovations in maxillofacial prostheses.
“We had a visit from a team from Hong Kong University and they extended an invite to us to come to Hong Kong to learn how to use 3-D imaging in creating prostheses.
“This technique uses a laser beam to scan a sculpted nose to produce a digital model of a new nose before a silicone prototype is made. We plan to adopt this system within the next two years,” he concludes.
No comments:
Post a Comment