Hopkins medical sculptor transforms lives, restores hope with facial prostheses

He’s worked with patients whose ears were bitten off in dog attacks. He’s seen people whose eyes or ears were lost in accidents or whose flesh was ravaged by aggressive cancers. And he’s helped others born without body parts or who suffered unimaginable gunshot wounds.

But even Juan Garcia is sometimes still taken aback by his work.

“Sometimes I’m seeing individuals who are missing a whole mid face,” explained Garcia, one of fewer than 40 board-certified clinical anaplastologists in the world – that rarest of professions that combines artistry and medicine in the design and craftsmanship of prosthetic devices.

“I’m looking into the nasal passageways, and I’m seeing a tongue as it’s trying to swallow through the orbital maxillary cavity,” said Garcia, director of the Facial Prosthetics Clinic within the Department of Art as Applied to Medicine at The Johns Hopkins University School of Medicine in Baltimore. “These are things that even for a seasoned professional will elicit a response of, ‘Oh, my gosh.’ ”

No matter what he may be experiencing emotionally, it’s Garcia’s job to bring hope and perhaps some sense of restoration to hurting people. His priority is to convey an atmosphere of ease for his patients, some of whom have never looked in a mirror after losing part of their face to cancer or an accident.

“I try to make patients feel like this is a safe space where I see you – I don’t see the affected area,” said Garcia,  a parishioner of Church of the Nativity in Timonium who has meticulously fashioned an estimated 500 prosthetic noses, ears, faces and other body parts over the years. “I see you as a person.”

The weight of his responsibilities can be enormous, but so too are the spiritual rewards that come with living out a calling that transforms lives around the world.

Humble roots

Born in Puerto Rico to a Cuban family, Garcia grew up in Florida. His mother was a seamstress and his father worked as an ­employee and then general manager of one of the religious statues stores operated by a specialty warehouse called Almacenes Gonzalez in Miami. Interested in art since he was a child, Garcia informally helped repair statues customers brought to his father’s workplace. The younger Garcia used a plaster-like compound to reattach an amputated head of a saint or a broken hand of Christ.

“The statues would have glass eyes in them,” Garcia recalled. “That was always very intriguing, this whole idea of this glass eye and the beauty of it.”

As a high school student, Garcia worked two years in a hospital emergency room in Miami, transporting patients in wheelchairs and sometimes assisting emergency room personnel by giving out iodine and sutures. Garcia vividly recalled the day a young man was rushed to the hospital after his face smashed into a steering wheel in an automobile accident.

“All his teeth were knocked out,” Garcia recalled. “They carried them in on a little paper towel.”

In all the “shuffling here and there,” Garcia said, the teeth were lost after someone cleaned the hospital room. Garcia frantically dug through trash cans, recovering the missing pearly whites, which were then implanted back into the young man’s mouth.

“I thought to myself, ‘Oh, my God, as a result of what I did, this kid has teeth,’ ” Garcia said. “This idea of something that you can do to help someone in such a facial disfigurement was impactful to me.”

Garcia enrolled at the University of Miami as a pre-med major. After several years of scientific study, he needed a break and took some art classes. He became so interested in the field that he switched majors. He earned a bachelor’s degree in graphic design/illustration and then decided to finish his bachelor’s degree in biology, too.

Looking to combine his divergent interests in art and medicine, Garcia applied to the medical and biological illustration graduate program at Hopkins – a first-of-its-kind course of study founded in 1911 under the pioneering leadership of Max Brödel.

It was at Hopkins where Garcia earned his master’s degree and came in contact with someone who made artificial eyes and facial prosthetics. He delved deeply into the field, emerging as one of the world’s foremost authorities in facial prosthetics. In 2009, he established a one-year training certificate program in clinical anaplastology.

“It’s humbling work,” said Garcia, a 50-something associate professor in Hopkins’ Department of Art as Applied to Medicine. “It definitely pushes me to create the best that I can out of silicone and clay and wax and color. It makes me feel like I have to constantly try to do better.”

Helping others

Jodie Ezell was born 57 years ago with a malformed left ear. She had a bit of an earlobe, she said, but no ear canal. Within her middle ear, three bones had formed as one.

From the time she was just six months old and continuing into adulthood, she had an estimated 25 surgeries to create an ear with her own skin and various sculpting materials including Teflon. She eventually had cartilage harvested from a rib to help in ear reconstruction.

With so many surgeries, however, blood flow couldn’t support the new skin and the reconstruction had to be removed. It was at that point that Ezell’s plastic surgeon asked if she had ever considered a prosthesis. Like many with her condition, she didn’t even know it was an option.

Garcia has designed several prosthetic ears for Ezell – new ones are needed every few years as colors change or the patient’s body changes. Each prosthesis is attached to bone-anchored titanium implants and is held in place with tiny magnets. Other patients rely on other methods of attaching devices, depending on their unique medical situation.

During a Nov. 8 session inside a cramped Hopkins office, Ezell sat in a chair as Garcia stood nearby, along with Jess Liddicoat, a 24-year-old graduate student from Arizona whom Garcia mentors in the university’s nascent master’s program in clinical anaplastology.

At Garcia’s direction, Liddicoat held up a prosthetic ear she crafted out of silicone. As she placed it next to Ezell’s healthy right ear, Garcia peered intently at the twin body parts.

“This would pass certification review,” Garcia said in his understated, but encouraging way.

The prosthetic ear was cast using multiple colors, the medical sculptor said, with Liddicoat using pigments suspended in a silicone fluid to paint over the already-painted prosthesis.

Ezell, who travels by train from Virginia for her Hopkins appointments, later gave Liddicoat a high-five as she was leaving. The ear Garcia’s protégé made, which was constructed in a parallel way to the actual prosthesis Garcia is working on, will become one of 18 different pieces in Liddicoat’s portfolio.

“You can’t really tell that it’s not my natural ear,” Ezell said with a smile. “It’s incredible.”

The patient acknowledged that she experienced some teasing growing up.

“Kids can be cruel, right?” she said. “They don’t know any better and they’ll point and ask questions. I think it was probably harder on my parents than it was on me because I don’t think it really bothered me. It bothered me that it bothered my parents.”

Wearing such a natural-looking prostheses is a confidence-booster, she acknowledged. It provides a lot of practical benefits, too.

“It’s pretty cool – the things you don’t think about, like being able to wear your glasses without them getting all askew,” she said, “or being able to tuck my hair behind my ear. It’s the little things in life. It makes a big difference.”

Howard Metger, who was born without a left ear, said he had seven operations by the time he was 6. He, too, has happily worn a prosthetic ear constructed by Garcia.

“I knew some people who had a prosthetic leg and arm and they were all just one color,” he said. “This (ear) isn’t like that. It has all kinds of shading. So it looks real.”

Garcia, whose patients come from as close as a few miles away and as far as South America and the Middle East, noted that prostheses typically cost between $5,000 and $8,000. That compares to plastic surgeries that can cost about $10,000 for each procedure.

Tedious work

Garcia, a former president and current president-elect of the International Anaplastology Association, said his field requires keen attention to detail to fool people into believing prosthetics are actual flesh and blood. Sessions with patients can last up to four hours or more at a time.

The process can include taking an impression that’s used in sculpting a prostheses. In recent years, Garcia has used a hand-held 3D scanner to help create models that can be mirror-imaged.

“One of the big challenges to the work that we do trying to make flesh out of silicone and pigment is that there are limits to the way that light reacts on that surface,” he said. “Blood cells and all the collagen and all the other cellular makeup reflects and absorbs light in a different way than a prosthesis does.”

Light has different temperatures and those different temperatures reflect differently, he explained.

“So what looks good in one light source may look different in another,” he said. “But we try to get it as close as possible.”

Medical sculptors are not physicians, Garcia emphasized, but they have to collaborate with medical doctors on such matters as determining where implants should be placed.

Gratitude

Garcia said patients, many of whom are struggling with pressing thoughts of their own mortality, often share their faith or want to discuss spiritual issues during their lengthy sessions with him. As a devoted Catholic, he said, he’s open to those conversations.

“I share my faith and they share their faith,” he said. “I pray many times about these families and these issues that they’re going through.”

Garcia also prays in the operating room. When he’s opening a mold, he asks God to “let it work out” so he can deliver a prosthesis for his patient.

He recalled an elderly patient whom some believed was not very responsive. When he gave the woman her prosthesis, she came to life and began “saying blessings” for him and wanted to do the same for a graduate student.

“Those are the moments when you realize there’s this higher power around all of us,” he said.

Garcia said he could never have afforded a graduate education at Hopkins had it not been for a full scholarship supported with funds from a predecessor who worked in his department. He yearns for a philanthropic donor to step forward to make a contribution establishing the first named scholarship benefiting students in Hopkins’ clinical anaplastology program. That would be a great help in training future generations to continue life-changing work across the globe, he said.

 “The injuries or affected areas (of our patients) can very much condemn them to a life of isolation,” he said. “That’s not good for any of us. We’re able to affect that. That’s something that I’m very grateful for.”

Email George Matysek Jr. at gmatysek@CatholicReview.org

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