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  Facial Artistry

Juan Garcia creates prostheses to treat severe disfigurement that cannot be corrected through reconstructive surgery. He first sculpts the piece, then paints it with painstaking precision to match the patient's skin tones.

By Dale Keiger
Photos by Keith Weller

Juan Garcia Jr. gives people their faces back. In many respects, he gives their lives back, too.

Garcia works as a medical illustrator and teaches ophthalmological illustration, medical sculpture, and digital art in Hopkins' Department of Art as Applied to Medicine. He also directs the Hopkins Facial Prosthetics Clinic as an anaplastologist. He fashions by hand prostheses that treat disfigurement caused by traumas, surgeries, or malformations — severe problems that cannot be remedied by reconstructive surgery. Victims of gunshot wounds, auto accidents, and animal attacks seek his services, as do people who were born with, say, incompletely formed ears, and especially people who have lost part of their faces to cancer surgery. He also sculpts custom pectoral implants to treat chest wall deformities. His prostheses are remarkable works of restoration.

"These patients either stay at home with a very large defect, or they come to see a person like me to create something that will allow them to interact socially again," says Garcia. "They've gone through a long medical process, years sometimes, and I'm often the last person they see. I take on a very important role in their final treatment."

When a patient comes to him, Garcia first takes a series of measurements and reference photographs, then makes an impression of the affected area. He uses the impression to fashion a preliminary wax piece that he sculpts right on the patient to match, as closely as possible, the contours of the patient's face or head. From this wax model he then creates a prosthesis out of colored silicone. He fits the prosthesis to the patient and meticulously paints it to match skin tones. The prosthesis will be held in place by either adhesives or a system of small clips or magnets that attach to implants. The patient can remove and clean the prosthesis daily.

Painting the piece is painstaking work demanding a great deal of artistry. "I have to think how light transmits through surfaces in order to finely gauge what's happening in terms of the color blending," he says. "I have to imagine light sources going through the surface of the prosthesis and hitting various layers that are built up. It's not just one color. You're putting in mixtures of colors, trying to imitate the histological layers of the skin and what's happening when there are blood vessels underneath it, how light is transmitted and may be reflecting from an artery or vein, bouncing off of fatty tissues which have a very different color than regular layers of skin. It's more than matching a swatch."

A poster Garcia created depicting a mechanism for the specific elimination of unwanted antibody production. Garcia, who began his college education at the University of Miami in Florida as a pre-med student with an interest in plastic surgery, works with two to three patients a month at Hopkins and also sees patients on a freelance basis in Virginia.

He keeps current with new research into biomaterials and attempts to cultivate living tissue in the laboratory. "Why not take a three-dimensional scan of an ear," he says, "then manipulate that scan to create a cartilaginous structure onto which you grow epithelial tissue, then incorporate that surgically onto a patient? We're just starting to think this way. Will they ever be able to create an eye in this fashion, that has the minute wrinkles and subtleties that are in the eye form? We don't know."

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