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You Say Cosmetics, I Say Cosmetic

“This patient desires a cosmetic prosthesis... nothing functional..” is a statement I hear every week from doctors, therapists, case managers, and even prosthetists. Why the distinction between cosmetic prosthetic devices and traditional ‘functional’ prosthetic devices? Is not something functional if it achieves what it was created to do?

Historically, prosthesis were only considered functional if they enable individual individuals to perform physical tasks, permit the body to move, or enable any number of active functions not previously capable without a prosthesis, this perspective has changed over the years and many health care providers now recognize the functionality of cosmetic prosthetics, in addition to recognizing their incredibly high rehabilitative success rate. However, the industry still has a long way to go.

Strangely, a main prejudice cosmetic prosthetic devices have is found within their name – the adjective ‘cosmetic’. When one reads or hears the word cosmetic, the first association quite often is cosmetics (make-up). Certainly cosmetics should never be considered medically necessary; after all, cosmetics are designed to enhance existing physical features – to beautify the face, hair or body.

Since make-up is the concept that is often though of when hearing the adjective cosmetics, let us contrast the goal of cosmetics (make-up) with the goal of cosmetic prosthetics. One may use cosmetics to enhance their eyes using eye shadow, eyeliner, mascara, etc. However one would use cosmetic eye prosthesis to replace a missing eye. One goal serves to enhance an existing physical feature while the other serves to replace a missing anatomical part. It seems silly to even make this comparison; yet cosmetic prosthetic devices are still quite often categorized within the concept of enhancing rather than replacing.

It would certainly seem cruel to inform a person missing an eye that eye prosthesis is not medically necessary because it is cosmetic. What should the amputee do? Should they have a non-cosmetic eye made out of wood or metal not looking like an eye at all? Would it then become medically necessary because it is not cosmetic? Of course not – having the prosthesis looking like an eye is the main reason for being the prosthesis created.

Prosthetic eyes and facial prosthetics in general, are virtually always recognized as medically necessary, yet an eye prosthesis is not functional in the traditional sense of the word; it never brings back the sight of the eyes. It is due to our God-given capacity to empathize with others that payers of medical benefits realize that people with serious facial defects will be object of morbid curiosity and discourteous stares wherever they go. Rehabilitation in these cases does not warrant traditional prosthetics but prosthetic devices that will camouflage the disfigurement, therefore only a cosmetic prosthesis will do.

Why then the prejudice against cosmetic restorations of the fingers, hand or feet? The concept is the same – to appear whole.

It is import for amputees and health care professionals to understand the etymology of this ancient word. Cosmetic comes from the Greek word, kosmos. One of its main definitions is “order”. Other definitions surrounding this word include “to be complete, well-ordered, and in proper order”. Thus, cosmetic prosthetic devices do just as the root word describes; they allow the body of the amputee to appear well ordered, and arranged according to the natural anatomical order of the human form.

So, why the prejudice against other body parts? It is primarily due to how these body parts are perceived that often disqualifies them for cosmetic restorations. Fingers and hands are mostly thought of as mechanical devices, where feet are what we use to go from one place to the next. Therefore, the common assumption in creating prosthetics for these limbs is to simply restore lost movement or prehension – not to make them look lifelike.

It is easy to see how traumatic a facial deformity can be in regards to ones identity because we identify people by their faces; but for those of us, who are not amputees, we generally associate our hands and feet with something we use – not something we are identified by. However, all too often amputees are secretly known in the minds of others as “the person missing the hand [or whatever limb is deficient]”. This is why so many more arm, hand, and finger amputees desire ‘ultra’ cosmetic prosthetic devices than lower extremity amputees. Since clothing does not cover their hands, they are recognized by their limb deficiency more readily than lower extremity amputees. No amputee wants to be strictly identified by their limb deficiency or a visually obvious prosthesis, but for who they are as an individual.

Although they will always be the need for non-cosmetic prosthetic devices to allow for advanced active function; today, more than ever, a growing number of amputees are more concerned with the appearance of being complete than the need for feeling actively restored through non-cosmetic devices.

About the Author:

Michael Kaczkowski, is the president and director of Anaplastology of Alatheia Prosthetic Rehabilitation Center. He is the creator of many prosthetic technologies including: livingskin®, Dermatos®, Derma~Flex® and many others.