IN THE FIELD
Q&A with anaplastologists across the globe
FPIR
What led you to pursue a career in anaplastology?
PADILLA
My path to becoming an anaplastologist began while I was an undergraduate art student at the University of New Mexico. I have always been interested in medical and anatomical art, so I split my time between sculpting and drawing in the studio, while taking anatomy courses as electives to improve my work. A lot of my work was centered around the lost wax casting process, which involved making wax sculptures and then duplicating them in bronze. After graduating, I worked as a university arts lab manager, where I operated sculpture and bronze casting facilities and taught similar techniques to students. It wasn’t until I began applying to Medical Illustration graduate programs that I discovered anaplastology as a field of study. Much to my surprise, many of the lost wax techniques I had learned were transferrable to the field of anaplastology, which was a very serendipitous coincidence. I was accepted into the University of Illinois at Chicago’s Biomedical Visualization graduate program, and I immediately focused my attention on the anaplastology track that was offered. After graduating from UIC, I had the opportunity to work in Belgium as a Clinical Anaplastologist, where I still work today.
FPIR
As a clinical anaplastologist, what kinds of prostheses do you provide? Do you specialize in any particular area of the body?
PADILLA
My first priority is always to try to help a patient to the best of my abilities, regardless of the type of prosthesis they may need. I specialize in implant-retained facial prostheses – primarily ears, noses, and orbitals – which make up the majority of the patient cases that I see. I also provide adhesive-retained facial prostheses in difficult situations, or when implant-retention isn’t a viable option for a patient. In addition to facial prostheses, I have experience fabricating aesthetic silicone covers for arm and leg prostheses, partial and full hands and feet, and both pressure-fit and implant-retained finger prostheses. Necessity is the mother of invention, so I’m always very interested in the more difficult cases, as they always require a fair amount of problem-solving, and often result in learning new techniques or fabrication methods.
FPIR
What techniques and technologies do you use in the process of fabrication?
PADILLA
As far as sculpting and texturing are concerned, I have adopted a combination of techniques that are commonly used in the art, dentistry, and special effects professions. I use traditional sculpting tools and dental instruments to achieve a broad spectrum of texture effects, and I’m always on the lookout for interesting materials and objects that can be cleverly repurposed into sculpting tools. For limb and digit prostheses, I use HCR silicones and a mill to create thin silicone sheets of different colors, which are layered and blended together. With this method the textures are sculpted directly into the silicone, rather than sculpting in wax and then duplicating the sculpt in silicone. 3D technologies, such as scanning, modeling, and printing, are also very useful tools that I try to incorporate whenever applicable.
FPIR
What skillsets have you found to be essential to be successful in your work?
PADILLA
I would say that coming from a background in fine art and having a lot of practice physically sculpting in different materials has definitely been a key factor to my success as an anaplastologist. Speaking from my own personal experience, I’ll mention lost wax casting again, as many of those skills were transferrable to anaplastology, as far as materials and techniques are concerned. Rather than learning an entirely new skill from scratch, it was more of a repurposing of a previously learned skill for a similar, but different, outcome. In addition to having sculpting experience, a strong understanding of human anatomy is essential. The more an anaplastologist understands about the intricacies of surface anatomy and the underlying structures, the more successful their results will be.
FPIR
What innovations have you drawn from or integrated into you workflow?
PADILLA
Utilizing 3D technologies has done a lot to help streamline my workflow in making a prosthesis. As students in the Biomedical Visualization program, we were encouraged to incorporate 3D modeling, scanning, printing, etc. into many of our projects, and to utilize these technologies in a variety of innovative ways. Rapid prototyping has gained a lot of momentum amongst anaplastologists as a means of improving the anatomical accuracy of a prosthesis overall, but also in speeding up some of the processes. As 3D scanning and printing technologies advance, the field of anaplastology as a whole will continue to benefit. Along these same lines, CT scanning and 3D modeling programs have made surgical planning for implant placement a much easier process. By evaluating bone density and discussing optimal implant placement with a surgeon, the overall results of a prosthesis can be greatly improved.
FPIR
What advances would you like to see in the field of anaplastology?
PADILLA
I’d like to see an increase in public awareness of the profession as a whole, as well as an increase in access to treatment for patients. There isn’t a lot of information available to the public regarding anaplastology, and the field can feel a bit isolated at times. Increasing the amount of information and resources available to the general public, online and through social media, for example, would potentially increase exposure and connect more patients to services they would benefit from. The majority of the population has very little knowledge, if any, regarding facial prosthetics, let alone where to look for treatment. When compared to the demand for treatment worldwide, access to anaplastology services is relatively limited, and there are many people in developing and remote regions who would benefit greatly from prosthetic rehabilitation. As 3D technologies advance, I think we will be able to offer a broader range of treatment options to help more people.
FPIR
What do you enjoy most about your work as an anaplastologist?
PADILLA
Having the opportunity to work one-on-one with patients, and being able to see the impact that a prosthesis can have for someone is a truly rewarding experience. Understandably, there can be a certain level of skepticism about the whole process from the patient, but the moment they see their new prosthesis in place for the first time is very fulfilling. As an anaplastologist, each new case is a challenge to make the best, most realistic, and seamless prosthesis you can, and each new prosthesis is a personal challenge to one-up yourself.
The other aspect of the job that I enjoy is the fact that I get to spend most of my day sculpting! I’m a craftsman by nature, and making things with my own two hands is very rewarding personally. I feel very fortunate to have a very hands-on and creative job, and often times my job rarely feels like work at all.
"If anyone, anywhere in the world cannot access our devices, then we [anaplastologists] have not succeeded."
- Daril Atkins, Certified Clinical Anaplastologist, Rashid Hospital, Dubai