The Art of Creating Artificial Eyes and Facial Prosthetics

During the summer months, we are revisiting some of our favorite BU Today stories from the past year. This week, we feature some notable BU alumni.

Kaylee Dougherty presses a sculpting spatula to clay, smoothing the contours of her morning’s work. She pours a mixture of resin and artificial stone around the clay to form a mold. When it’s set, she’ll fill the mold with pigmented silicone to create an astonishingly lifelike final product.

While most sculptors intend for their work to be seen and admired, Dougherty (CFA’11), an associate at Boston Ocular Prosthetics, Inc., hopes that this piece will go unnoticed. She recently earned certification as a clinical anaplastologist and is training to become a certified ocularist. As an ocularist, she creates artificial eyes for patients born without eyes or for those who have lost them to accident or disease. As an anaplastologist, she sculpts facial prostheses for an array of patients—a man who lost his nose to skin cancer, a girl born with an underdeveloped ear, a woman whose eye was destroyed in a car accident.

“Everything is custom,” she says. “Each piece we do is hand-sculpted, is hand-painted or hand-pigmented.” The goal is to match the prosthesis so precisely to her patient’s natural features that her artwork is mistaken for the real thing.

Dougherty works alongside her employer and mentor, Ottie Thomas-Smith. Both trained sculptors, they fabricate artificial eyes using dental-grade acrylic, adding red silk thread to replicate veins and mixing pure pigment to create custom eye colors. For facial prostheses, they work primarily in silicone, which they tint with dry pigment to match a patient’s skin tone.

Dougherty and Thomas-Smith spend most of their time in the Boston Ocular Prosthetics main office and fabricating lab in Jackson, Maine, a tiny town southwest of Bangor that provides a peaceful setting for focusing on their work. They also visit satellite offices in the Boston area regularly, to meet with patients to take impressions, make sure prostheses fit properly, and provide maintenance. Ocularistry patients make regular appointments just as they would with their dentist. “We like to see our patients once or twice a year,” Dougherty says. “We clean and polish the eye and check it to make sure there’s nothing that needs adjustment.”

All of her patients are referred by a physician, and because their prostheses are necessary, they are covered by medical insurance. “They aren’t just cosmetic,” she says.

A prosthetic ear helps direct sound waves into the auditory canal. A prosthetic nose filters and moisturizes incoming air. An artificial eye keeps the eyelid in position and helps tears drain properly. When a child is missing an eye, the eye socket can stop growing, causing the child’s face to develop asymmetrically. Wearing an increasingly larger prosthetic eye can stimulate growth of the socket, encouraging normal maturity of facial bones and tissues.

“Everything we make has a purpose beyond just making this person look normal again,” Dougherty says. “Of course, I can also put an ear piercing in for a teenage girl. It’s not going to hurt, so we might as well go for it.”

Finding her calling

Dougherty says the reason she chose to major in sculpture at CFA was that she “wanted to do sculpture when I was seven years old. It’s all I’ve ever wanted to do.

“I love the physical aspect of sculpting—the act of it,” she says. “But I didn’t ever see myself having a studio somewhere and trying to sell what I was making, or being in galleries. I always wanted to work with my hands, and I knew getting a degree in sculpture would get me the knowledge I needed to do a lot of different things.”

School of Visual Arts sculpture graduates apply their knowledge of form and visual relationships to a range of careers, says Jeannette Guillemin, the school’s director ad interim, from theater set design to retail displays to 3-D animation.

Dougherty learned about the anaplastology field as a BU senior and immediately realized that it matched her interests: working with her hands, working with people, and making a positive difference in the world. She researched the requirements to become a certified anaplastologist—a combination of scientific and studio-art course work and three years of supervised training. She had already completed all of the required art classes and some of the science classes at BU. After graduation, she took the remaining course work—medical terminology, human pathology, and human physiology—through the School of Medicine’s Division of Graduate Medical Sciences and began searching for a mentor to supervise her clinical training.

She was surprised to discover that of the nation’s nearly three dozen anaplastologists, only one was based in New England: Thomas-Smith, who has a dual specialty in anaplastology and ocularistry. Dougherty called her and asked if she could see her work firsthand. Thomas-Smith had upcoming appointments scheduled in her Boston office and invited Dougherty to meet with her there.

“So she came,” says Thomas-Smith, “and I can’t remember specifically who the patients were, but I do remember them being rather interesting. You know, large facial patients—people with portions of their faces missing.” Seeing these cases, she felt, would be a good introduction for Dougherty to the realities of the work.

“The first patient I met,” Dougherty remembers, “was a man with an artificial eye. He came in and sat down, Ottie introduced me, and he just took out his eye and handed it to me.”

“And God bless her,” Thomas-Smith says, “she was interested. She acted extremely appropriately and professionally, was very sweet when asked anything by the patients. There was one patient who lobbied for me to hire her immediately.”

Creating relationships

Dougherty joined Boston Ocular Prosthetics as an apprentice in May 2013. She passed the anaplastology certification exam last year and expects to take the ocularistry exam in 2018. Thomas-Smith says she looks forward to retiring eventually and turning her business over to Dougherty, who she knows will take good care of her patients.

Building relationships with patients is a large part of Dougherty’s work and one of the things she loves most about it. Her youngest patient was a six-day-old girl born with only one eye. That infant is now a two-year-old who always greets her with a hug. “My oldest patient is 97,” she says, “and I go to her house because it’s difficult for her to get down to our office.”

Taking time to know her patients not only makes Dougherty’s work more enjoyable, it can also improve patient outcomes. When she first met John, who had lost both eyes to childhood retinal cancer, she asked him detailed questions about his life and daily habits to help her best meet his needs.

John had been wearing a patch over his more damaged eye socket and an artificial eye in the other. “But because of the radiation treatments over the years,” Dougherty says, “he couldn’t wear the artificial eye anymore.”

She wanted to make John two orbitals—prostheses that replace the eye and its surrounding tissue—but she worried that a blind patient would have difficulty placing two separate prostheses correctly. She asked him if he lived with anyone, and he told her that his wife was also blind. Since he didn’t have anyone to help with daily placement and he’d comfortably worn sunglasses for years, Dougherty borrowed an old-fashioned technique and made him a spectacle-held prosthesis—two orbitals attached to a simple pair of eyeglasses.

“I was able to make him something that was comfortable and wearable and that he could use every day and know it was going to be in right,” she says. “It’s an example of how you really have to talk to someone and get to know the person.”

She knows that having two lifelike eyes helps John interact more easily with friends and business associates. “I like making a difference on that very micro level,” she says. “It’s one person at a time, but it makes a big difference to that individual person.”

Patients often ask Dougherty if she still makes art. She laughs at the implication that what she’s doing for them—sculpting an ear, painting an iris—isn’t “art enough.”

For her, she says, it very much is.