Matthew Houdek, a mortgage banker who wears a prosthetic ear, says he no longer shields his left side from public view. (Tribune photo by Abel Uribe / March 27, 2009)
Prosthetics: Specialist gives artificial facial features a personal touch
'You can never make the prosthesis good enough,' Greg Gion says
By Angie Leventis Lourgos | Special to the Tribune
April 10, 2009
As Matthew Houdek gets a routine haircut, his face in the mirror appears free of any deformity or abnormality.
But the stylist can see the mass of red tissue hidden behind his left earlobe and is careful to avoid the scar that runs across the side of his scalp. Houdek gives the beautician fair warning to look away. Then he removes his left ear, cupping it in his hand. He gives it a tug to demonstrate its durability and flexibility.
His right ear is real. His left is made of silicone, affixed to his face with magnetic screws that were surgically implanted into his skull. When the prosthesis is attached, it's difficult to tell which ear is natural and which is fake.
The 25-year-old Bucktown resident has microtia, a congenital ear deformity with hearing loss. He was born with just the bottom of his left lobe—no eardrum or ear canal.
Matthew Houdek's prosthetic ear
(Chicago Tribune/Abel Uribe)
He wore the new ear for the first time recently—a testament to advancements in the field of facial prosthetics over the last quarter-century. Anaplastologists can create ears, noses, fingers and parts of the mouth and eyes that rival the originals. They can take 3-D images of a patient's other eye or ear—or the nose of a relative who looks similar—to get the shape and size just right. Recent improvements have been achieved in the design, tint and attachment of the prosthesis.
Houdek no longer has to explain his appearance to small children. He doesn't subconsciously shield his left side from public view on the street, in elevators or while riding the elevated train. "I can sit however I want," he said. "I don't have to worry about it."
Artificial ear evolved from cartilage to silicone
Houdek has partial hearing on the left side. He might hear "duck" when someone says "truck," and loud noises can interfere. He can't understand much over the buzz of the electric razor as the stylist trims the back of his neck.
As a baby and toddler, he lived with just a small flap of flesh and no hole where the ear canal normally would be; he heard sound through vibrations in his ear bones.
At 4, his parents decided to have doctors construct a fake ear out of cartilage taken from his rib. The little piece of flesh was removed and the reconstruction looked like an ear made of melted wax: It was one color, lay flat against his head, and lacked the ridges and valleys that define a natural ear.
As Houdek and his real ear grew, the fake one remained child-size. The abnormality became more noticeable as he aged.
"I was very conscious of it," he said. "I would say that it shaped my personality. I was more shy and reserved."
In November, he underwent surgery at the Loyola University Chicago Stritch School of Medicine, where an ear, nose and throat surgeon constructed an ear canal. The hope was that it would improve Houdek's hearing, but his ear bones had fused in a way that rendered the surgery unsuccessful.
The cosmetic changes were more promising. A surgeon sliced off the old ear and inserted several magnetized screws into the thicker portion of Houdek's skull, in preparation for a prosthesis. As the wounds from surgery healed, his new ear was being crafted a few hours away in Madison, Wis.
Specialist brings artist's perspective to his prostheses
About the time Houdek was born, facial prosthetics specialist Greg Gion was establishing his practice in Dallas. He originally wanted to be an artist, but found a more practical application for his talent while studying medical arts at the University of Illinois at Chicago.
He said few people specialized in facial and hand prostheses at the time. Most created limbs full time and did other appendages as side jobs. A natural replica was an aberration rather than the norm. But to Gion, faces and hands were more intimate than arms and legs—less functional but more personal. So he sought to perfect the prosthetic ear, nose, eyelid—even parts of the mouth.
He hated the use of adhesive. The glue was messy and unnatural, and patients feared their appendages would fall off if struck hard or if they perspired too much.
Dentists were using magnets to hold dentures in place, so specialists in facial prosthetics started experimenting with similar technology in the 1980s. The Food and Drug Administration approved magnets for this use in the mid-1990s, and they were strengthened and incorporated into a clasp roughly five years ago, Gion said.
Experts in the field started forming professional societies and sharing their knowledge, resulting in more natural-looking products, he said. A prosthesis—which costs $3,000 to $7,000—is covered by most insurance plans, he said.
In his Madison office, he made Houdek's ear by creating a mold of Houdek's right ear and inverting it. He then tinted the silicone with blushing and freckles and feathered the edges to avoid a seam when attached to the face. Houdek watched as Gion took pains to match every shade and ridge to the natural ear.
"You can never make the prosthesis good enough," Gion said.
Behind his work is a bit of an internal struggle: There are times when he sees a child with only part of an earlobe or a small nub, and wonders if it even needs to be removed in favor of a prosthesis. Sometimes he wishes society would be more accepting of people who look different, rather than compelling the individual to change.
He has created more than 1,000 prostheses, and each case is different. There's the gunshot or motor vehicle collision victim who might need to wear a false appendage just to move on from the trauma. There's the elderly patient with waning vision who has trouble reinserting and cleaning a false eye, and an eye patch might be a better solution. "In the end, it's a personal choice. And most of us don't know what it's like. We take it for granted that people aren't staring, that we blend in."
To those who are closest, appearance doesn't matter
Before leaving the hair salon, Houdek pops his ear back on. He removes it when he swims and sleeps to protect the pigment.
He'll need a new prosthesis every three years because of wear and tear and to keep up with the natural ear, which will continue to change as Houdek grows. "Obviously I don't have a 60-year-old-man ear," he said. "But I will someday, and I'll need one to match."
The change in him is most dramatic when he's in public: Strangers no longer do a double take when passing his left side. And this is freeing. Houdek's family and girlfriend were happy, but he doesn't think matching ears are of much consequence to those closest to him. When he wore the prosthesis around a group of friends for the first time, he was surprised that no one noticed for about 20 minutes. He had to draw attention to the new ear.
They were flabbergasted that they'd missed it. "They don't really see it regardless, whether it's the old ear or the new ear," he said.