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Craniofacial Care - Here's looking at you.

Anaplastologist David Morrison fits long-time patient Becky Thomson with a nose and partial-cheek prosthesis.

Doug Nicholson

Sunnybrook's expert physicians and prosthesis artists help patients with even the most obvious facial differences put a brave new face on life

For almost 25 years, a unique Sunnybrook facial prosthetic service has helped 86-year-old cancer survivor Becky Thomson live life to the fullest. "It changed my life for the better," Becky, a former special education and music teacher, says of Sunnybrook's Craniofacial Prosthetic Unit, where she's been getting artificial noses since the late-1980s.

She came to the unit – just one of two dedicated, full-time, multidisciplinary units in Canada – in 1988 on the eve of surgery to remove skin cancer on her face. She'd already waged a 10-year battle with facial skin cancer, winning multiple skirmishes along the way but never decisively defeating it.

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In February of that year, Becky was told the cancer was out of control. Sunnybrook surgeons removed most of her nose and part of her right cheek, and while the surgery was a success, it changed her face significantly.

David Morrison and Todd Kubon are the unit's two anaplastologists: the experts who carefully craft artificial noses, ears, eyes and other craniofacial parts for patients with facial differences. Their work is as artistic as it is technical, sculpting new facial features out of silicones and mixing paints to match the patient's
skin tone.

"I'm amazed at their skill," Becky says of the two who have treated her since they arrived at the unit in 1999. Dr. Ralph Gilbert, a former Sunnybrook head-and-neck surgeon now based at another Toronto hospital, and Wendy Grennier, the unit's office manager, form the rest of the unit.

Thanks to Becky's experience with a facial difference, she found new ways to help people, such as volunteering for many years with AboutFace, a non-profit organization that aids people with facial differences and raises awareness. She
has spoken at multiple conferences in North America and been interviewed
on television.

An outgoing and jocular personality, Becky says her artificial nose has helped her live life more fully. This has included singing in the Toronto Mendelssohn Choir for more than 40 years, travelling extensively and staying active with friends. "You have to get out there and show people you're still a person, that you still have life and still have something to contribute," she says.

Becky stands with members of Sunnybrooks's Craniofacial Prosthetic Unit: anaplastologists David Morrison and Todd Kubon, and office manager Wendy Grennier.

Patients are referred to the Craniofacial Prosthetic Unit via three streams. There are cancer survivors like Becky, as well as people who have suffered traumatic facial injuries or who were born with facial differences. Patients have three options following their initial consultation: One is to do nothing at all. As Morrison notes, sometimes potential patients are pressured by family or friends to consider a prosthesis they don't really want. Other options are to undergo reconstructive surgery to improve a facial feature or to get a prosthesis. Facial prostheses are temporarily attached to the face in one of two ways: with an adhesive or with bone-integrated implants.

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Becky spent nearly three years with an adhesive-retained prosthesis before undergoing a process known as osseointegration, whereby small titanium fixtures (screws) are implanted into facial bone. The result of this two-step process is that a prosthesis can be securely attached to the patient's face without adhesives.

The satisfaction Becky and so many patients get from their prostheses – they keep doors open for many patients who would otherwise become reclusive – is the reason Morrison and Kubon got into the profession.

Kubon had wanted to be a medical illustrator since the age of 13, and during his master's degree he focused on computer-based illustration. But he was instantly drawn to anaplastology when he made his first prosthesis for a patient during a clinical anaplastology course. "I had, in a very short time, made a difference in someone's life," Kubon says.

Their work goes beyond simply creating prostheses. "We coach the patients to adjust to their lives with their new prostheses," says Morrison, noting various techniques that help camouflage prostheses, such as wearing glasses along with an artificial nose.

And while neither Morrison nor Kubon are psychologists, they have many years of experience with patients struggling with facial differences. The two offer informed advice, but as part of the unit's multidisciplinary care patients also have access to Sunnybrook psychologists, as well as dietitians and social workers. They can also be put into contact with organizations such as AboutFace.

"Patients often come to us when there's a change in their lives – they're at a crossroads," says Morrison, citing patients starting a new career as just one example.

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While the Craniofacial Prosthetic Unit and its services are not a cure-all for patients, they are vital for many, he says. "We have seen patients who have taken on an entirely new lease on life that they would not have otherwise."

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