Individuals who have lost a part of their face due to trauma or cancer, often make use of a so-called facial prosthesis. This silicon aid replaces a missing eye socket (orbita) or nose. Such a facial prosthesis is a cosmetic devices: by wearing it, the face of affected people appears normal and whole rather than disfigured. In this study, we seek to understand the way in which facial prostheses establish a normal facial appearance. To answer this question, we make use of interviews we conducted with 20 people who wear a facial prosthetic device.
After having analyzes these interviews, we found that the simple act of attaching the prosthesis to the face does not automatically lead to a normal looks. To appear as part of the face, rather than as a foreign object apart from it, the prosthesis must fit the face well. The participants in our study put in much work to achieve such a good fit between the prosthesis and their face. This work takes the form of three different types of ‘fitting practices’:
- Respondents work to make the prosthesis fit their face. Many of these individuals constantly monitor their prosthesis in order to make sure it is aligned, does not come off, and does not let go at the borders. In this way, they try to prevent the prosthesis from betraying its artificiality. One interviewee, for instance, always makes a horizontal cut in the edge of stiff and inflexible prostheses that have reached the end of their lifecycle. This allows the prosthesis to follow his face as it moves when he is speaking animatedly, laughing or eating, so as to prevent gaping.
- Respondents make use of different props to make their prosthesis and face fit well together. Some participants who wear an orbita prosthesis make use of glasses with a thick frame in order to hide the transition between skin and silicone. One interviewee with a nose prosthesis uses theatre make-up to ensure the prosthesis’ color matches her skin tone, another uses a sun lamp to maintain his tan throughout the winter, so as to fit his complexion to the prosthesis’ shade.
- Respondents adjust their face and body in order to make the prosthesis less noticeable. Thus, some participants who wear an orbita prosthesis opt for a specific hairstyle that hides the upper part of the prosthesis. Others stop blinking with their remaining eye, so that the contrast with the unblinking artificial eye remains undetected. One interviewee who uses a nose prosthesis does not move her face too much, to minimize the risk of it falling off. Some respondents take care to walk in the shade, or keep to a corner when they sit in a restaurant or café – they monitor and adjust to their surroundings in order to make sure the prosthesis does not stand out.
These efforts, necessary to make the prosthesis and the face fit well together, are experienced by many participants in our study as bothersome and a hassle.
The fitting practices respondent undertake do not only target their prosthesis and face/body, however. They also affect the way in which respondents are able to go about their everyday activities in public areas. In order to maintain a good fit when such a fit is threatened, most interviewees require access to an enclosed, private space that contains with a mirror, running water adhesive and cleaning , and a shelve to put everything on. This means respondents must carefully plan and prepare for outings and vacations, and cannot just leave the house on a whim. Participants also adjust their schedule, priorities and (social) activities, in order to ascertain the good fit between their prosthesis and face is not threatened.
But why do these individuals go to such lengths to maintain a good fit? People who are unused to seeing a partly amputated face, can become confused and alarmed when confronted with the unexpected image it present. Such confusion and alarm arise due to the fact disfigurement disrupts the human capacity to recognize faces. A properly fitting prosthesis recovers facial recognition: it appears as a natural part of the face, rather than an artificial supplement. Facial prostheses do not only cover the absent facial area, like a bandage or eye patch would, but also conceals this absence. The prosthesis then becomes ‘transparent’: it disappears from view, retreats into the face, and becomes part of it. The facial prosthesis not only covers the face, but also recovers a semblance of facial wholeness.
By wearing a well-fitting prosthesis, the participants in our study in fact become able to ‘pass as normal’: their face looks complete, and thus no other than others’ faces. Such a normal, complete appearance mediates interviewees’ ability to interact with others. This happens in two distinct ways:
- The prosthesis allows respondents to move in public spaces unhindered by others’ unwanted attention. These individuals’ visible difference is quite conspicuous when they wear an ill-fitting prosthesis, an eye-patch, or dressing, or if they would go outside barefaced. Their unusual appearance then elicits staring gazes, remarks and questions from others. A properly fitting, transparent prosthesis prevents such unwanted attention, because it safeguards its user’s anonymity.
- The prosthesis enables interactional ease in face-to-face exchanges. During such exchanges, the facial difference – whether due to the amputation itself, a visible cover or an ill-fitting prosthesis – may confuse and distract participants’ conversational partner. The flow and ease that normally characterize face-to-face interactions then becomes disrupted. A well-fitting, transparent prosthesis recovers the conversational partner’s ability to see a face, rather than the disfigurement.
Recovering their normal facial looks by means of the facial prosthesis, as we show, is pivotal to interviewees’ ability to inhabit public spaces and interact with others. This means that the traditional divide between ‘cosmetic’ prostheses that are worn only for the sake of appearance and ‘functional’ prostheses that enable their users to perform various tasks does not hold. Facial prostheses are per definition cosmetic aides, but therefore no less functional.