Facial prosthetics: rebuilding a face after cancer or injury

The work

The Royal Melbourne Hospital is a centre for facial prosthetic rehabilitation, where specialists make eyes, ears and noses, as well as fingers and toes.

The patients are people who have survived skin cancer or serious injury, and who have lost a visible part of the face in the process. Advanced surgical technique saves lives; what follows is the problem of living publicly afterwards.

This page summarises a report on that work broadcast on the ABC's Lateline programme, in which A/Prof. Patrishia Bordbar and prosthetist Greg Peart described the process, and one patient, Steve Sparks, described what it meant to him.

How a facial prosthesis is made

1. The face cast

A cast model of the patient's face is taken. That becomes the foundation for making the prosthesis.

The reason is precision: the surrounding anatomy is already in place on the model, so a wax prosthesis fitted to it gives the closest possible replication of what the final result will look like — before anything is made in silicone.

The same logic governs a wax try-in for a denture, and the composite mock-up used before cosmetic work — see the mock-up reveal and the mock-up: why you should see your new smile before any treatment begins. You build it in a reversible material first, and only commit once it is right.

2. Matching the skin

This is where the work becomes something closer to portraiture. As Greg Peart describes it, there is a range of materials to imitate skin tones, around a dozen types of veins that can be added to the silicone, and an array of artist's oil colours.

Mixing those to the formula that matches the individual is the aim of the game.

A prosthesis is not selected from a catalogue. It is matched to one person's skin, in the light they live in. Dental ceramists work the same way with porcelain — the Smile Solutions laboratory is where that happens here, and what is the difference between composite veneers and porcelain veneers? explains why translucency and layering matter so much to the result.

How they attach — the change that mattered most

Facial prosthetics are not new. A/Prof. Bordbar notes they can be traced back to ancient Egypt and China, where prostheses were described as made of wood, clay, even gold and silver. Humans have always tried to replace missing body parts.

What has changed is attachment.

Adhesives

Initially prostheses were taped, or held with adhesives. That was frustrating — adhesive had to be applied daily, maintenance was difficult, and there was the possibility of social embarrassment if the prosthesis became dislodged.

That last risk shaped how people lived. A prosthesis you cannot trust is one you stay home with. Anyone who has worn a conventional denture will recognise the problem exactly — 5 things you should know about your new dentures, caring for yourself and your immediate dentures and dentures.

Magnets on titanium implants

Titanium implants are placed into the bone. The bone grows onto the titanium, and magnet keepers are held permanently on the titanium abutments.

It is the same principle as a dental implant — osseointegration — applied to the face. The result is a prosthesis that clicks on and off securely and reliably, which is what makes normal life possible again.

In the mouth, that same principle is what separates a plate that moves from a set of teeth that does not: see what do I need to know about dental implants?, what are the different types of dental implants? and what are the different types of dentures (partial vs full vs implant retained)?. Where a full arch is involved, things to consider when choosing All-on-4 Dental Implants® and All-on-4 dental implants describe the equivalent approach. Where the bone that would hold the implant has been lost, bone grafting is the preliminary step.

Why demand is growing

At this centre, two thirds of clients are skin cancer patients.

A/Prof. Bordbar attributes the growth partly to rising skin cancer incidence in Australia over recent decades, and partly to surgical progress:

Tumours once deemed inoperable meant palliative care, with no further treatment available. As surgeons became able to operate safely on some of those tumours, the result was what she calls “the reconstructive conundrum” — patients who survive, and now need to be rebuilt.

Cancers that begin inside the mouth raise the same problem, and are found earlier when someone is looking for them. Oral cancer: how your dentist can help with early detection, oral cancer: signs, risk factors and how your dentist can help and what are the causes, symptoms and treatment of mouth cancer? describe what a routine soft-tissue examination is looking for — and Daffodil Day: raising awareness of dental dangers covers the awareness campaign. The two largest modifiable risk factors are covered in are e-cigarettes bad for my teeth? and the effects of vaping on your oral health.

What the published figures say about mouth cancer

The skin cancer figures quoted above are A/Prof. Bordbar's. For cancers that start inside the mouth, there are published Australian numbers, and they make the same argument for early detection that this whole article makes for reconstruction afterwards.

Writing in the Australian Journal of General Practice in December 2024, researchers describing the Victorian Oral Cancer Screening and Prevention Program set out the position. Oral cancer is among the top 10 most common cancers in Australia, and in 2022 an estimated 5,189 Australians were expected to be diagnosed with head and neck cancer. Their assessment of the outlook is blunt: oral cancer has a relatively low five-year survival rate, at around 50%, mostly due to diagnostic delays. An Australian study they cite found an average diagnostic delay of approximately four months between symptom onset and initial histological diagnosis.

The reason delay is so common is a feature of the disease rather than a failure of nerve. Initial lesions of oral cancer are generally painless. There is nothing to prompt the appointment. The same paper sets out what should prompt one: any unexplained or non-healing change in the mouth lasting more than two to three weeks — a persistent ulcer, red patches, lumps, a sore throat, or red or speckled lesions — warrants an oral cancer screen. It names the lateral margins of the tongue and the floor of the mouth as the highest-risk sites, which is exactly why an examination that only looks at teeth is not an examination.

The risk factors it lists are age over 45 (especially in men), tobacco use, alcohol consumption, areca (betel) nut chewing, and limited access to dental care. The authors also note an emerging subgroup of non-smoking, non-drinking middle-aged women with tongue cancers, which is a caution against ruling anyone out on the basis of habits alone.

One further figure explains why the paper is addressed to general practitioners rather than dentists: in 2020–21 only 48% of Australians had seen a dental professional in the previous 12 months, against almost 90% who received at least one Medicare-subsidised service in 2021–22. The people at highest risk are, on the whole, the people least likely to be in a dental chair. If you are due, how often should I go to the dentist? and start the new year with a dental check cover the visit at which this examination happens.

What it means to a patient

Steve Sparks, a former funeral director, had an artificial eye, a liver transplant, dentures, ear surgery — and then skin cancer that required the removal of his nose.

His first reaction to the news was that he would have to shut himself away for the rest of his life. Facing a mirror took time and courage.

What he described looking forward to, once fitted, was not dramatic. It was being able to put his head under the shower and feel water on his face — something he had not done in over a year.

And about the finished prosthesis: unless he mentions it, people do not realise. The glasses holding it in place are plain glass.

The gap identified

Greg Peart raised a point about access: people often have to lobby for support to get to Melbourne to have a prosthesis made.

His argument is straightforward. If there is first-world cancer treatment, there should be first-world facial prosthetic rehabilitation to back it up. Where surgery removes part of a face, prosthetic rehabilitation is the necessary next step, not an optional extra.

Where this sits in dentistry

The hospital work described above is maxillofacial prosthetics, which is hospital-based and referral-only. But the two specialties it draws on are ordinary parts of a dental practice:

Both are formally recognised specialties, not descriptions a dentist can adopt. The Dental Board of Australia lists 13 dental specialties approved by the Australian Health Workforce Ministerial Council: dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial surgery, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry), and special needs dentistry. On top of the specialist qualification itself, the Board's specialist registration standard requires an applicant to have completed a minimum of two years of general dental practice and to meet all the requirements for general registration as a dentist. AHPRA publishes the register, and it records which specialty or specialties a dentist holds — so the title can be checked in a minute by anyone.

Where several specialists are involved in one case, complex dental cases: what happens when multiple specialists need to collaborate and complex dentistry describe how the sequence is planned. Why would I need to see a dental specialist? and dentists and registered specialists explain what the title means and how to check it.

Common questions

Is a facial prosthesis held on by the same technology as a dental implant?

The principle is the same — titanium placed in bone, bone growing onto it, a prosthesis attaching to what sits above. The evidence base is not the same, and it is worth being careful about that, because the two get conflated.

What is published in quantity is dental implant data: titanium placed in the jaw to carry teeth. A large registry analysis of 158,824 implants placed between 2014 and 2022 in one Israeli health fund reported an overall survival rate of 97.79%, a total failure rate of 2.21%, and noted that failures within the first year accounted for 1.59% — in other words most failures that happen, happen early. The International Team for Implantology's consensus statements put the cumulative survival of implants supporting fixed bridges at 95.4% after 5 years and 92.8% after 10 years, and for implants placed to retain an overdenture reported 2.5% loss before the denture was fitted and close to 6% loss during 5 years of function.

None of those numbers describe craniofacial implants carrying a nose, an ear or an orbital prosthesis. Different bone, different loading, and in many cases a site that has been operated on and sometimes irradiated. Borrowing a dental survival figure and applying it to facial prosthetic rehabilitation would be a misuse of it, and the honest answer to "how long will it last?" in that setting comes from the treating hospital unit, not from this page.

What actually goes wrong with implants, and how often?

More often than the survival figures alone suggest — because "the implant is still there" and "nothing has gone wrong" are two different measurements.

The ITI consensus data on implant-supported fixed bridges is unusually candid here. Across the cohort studies, only 61.3% of patients were free of any biological or technical complication at five years. The individual rates: peri-implantitis and soft-tissue complications in 8.6% of patients at 5 years; screw loosening or fracture in 7.3% at 5 years; fracture of the veneering ceramic or framework in 14.0% at 5 years; and implant fracture itself in 0.4% at 5 years, rising to 1.8% at 10 years. Where restorations were cemented rather than screwed, loss of retention occurred in 2.9% within 5 years and 16.2% within 10 years.

Read together, those say something useful: the titanium in the bone is the reliable part, and most of what needs attention over a decade is the hardware and the ceramic on top of it. That is a maintenance commitment rather than a failure, and it is the part worth asking about before treatment — who reviews it, how often, and what a repair involves.

Why does the specialist list include both "oral surgery" and "oral and maxillofacial surgery"?

Because they are two separate specialties, each recognised in its own right. Both appear on the Dental Board of Australia's list of the 13 approved dental specialties, alongside a third surgical-sounding entry, oral and maxillofacial pathology, which is a diagnostic discipline rather than an operating one.

The Board publishes the definitions and the corresponding specialist titles in its list of specialties document; the titles are not interchangeable, and a practitioner holds whichever one their registration records. The practical check is the same in every case: AHPRA's public register records the specialty or specialties a dentist holds, so you do not have to rely on how a website words it. It takes about a minute at ahpra.gov.au.

One thing the register cannot tell you is whether a particular person is the right one for a particular problem. That is what a referral conversation is for — and where a case spans several specialties, complex dentistry describes how the order of treatment is agreed.

Related reading

Practical details

Summarised from a report broadcast on the ABC's Lateline, featuring A/Prof. Patrishia Bordbar, prosthetist Greg Peart, and patient Steve Sparks. Quoted material is attributed to them.

The oral cancer figures in this article are drawn from a December 2024 paper in the Australian Journal of General Practice on promoting oral cancer screening by general practitioners, and the specialty registration requirements from the Dental Board of Australia. The implant survival and complication figures are from a large-scale electronic dental registry analysis and from International Team for Implantology consensus statements, and describe dental implants rather than craniofacial ones. All of these change over time; check the current publications.

Maxillofacial prosthetics is a specialist field. If you have been referred for facial prosthetic rehabilitation, your treating surgeon or hospital unit is the right first point of contact.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. The clinical team is listed by name.

Published 4 September 2015. General information only; it does not replace advice from your treating practitioner.

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