SAN JOSE, Calif. (KGO) -- Anaplastology is the replacement of parts of the face that have been surgically removed because of cancer or traumatic injury.
Maddie Singer, an experienced anaplastologist with Medical Art Prosthetics, often works from her satellite office in San Jose, welcoming her patients for three to four days and helping them regain their identity and improving their quality of life. Using her artistry and experience in the special effects industry, and a passion for helping others, Singer creates some of the most life-like facial prosthetics in the country.
For survivors of skin cancer, particularly of the face, there is an often-untold battle left behind after numerous devastating surgeries.
"Even though he had all these surgeries, and he was going through it," says Zaida Alfonzo about her dad, Nelson. "I can tell he's not the same person."
Zaida, one of Nelson's seven daughters, says they always noticed that their dad had a mole on his upper lip, just below his nose.
"We, his daughters, kept telling him 'Hey, that doesn't look right,'" Zaida said. "But, like most men, he kept putting it off."
In 2010, Zaida says that's when the discoloration of the mole began to scare her dad. But it wasn't until 2017 that Nelson started the procedure to remove the cancerous tissue below his nose. From 2017 to 2020, Nelson endured 15 surgeries, ranging from tissue removal, skin grafting, and a tracheostomy.
Nelson survived the surgeries and the cancer was removed, but what was left was a missing palate, a surgically reconstructed upper lip, countless scars throughout his body, and a gaping hole where Nelson's nose used to be.
MORE: 'The best day ever': 2-year-old South Bay girl celebrates end of cancer treatment
There was also an invisible wound left behind, as Nelson struggled to adjust to his new face.
"Before he had gone through this," said Zaida. "He would always mess with us and just joke and had this different aura. And then this happened."
Nelson, who only speaks a little bit of English, says through Zaida's translation that in his life, he has always carried himself in high regard.
Nelson was born in Venezuela and grew up in Italy, where he studied and played soccer. As an adult, he moved back to Venezuela where he was a successful businessman. When he came to the U.S. in the 1990s, his social skills allowed him to continue his success despite not knowing the language.
And if you were to ask him, he'll tell you he was also very handsome.
"He says, 'That's why I have seven daughters,'" Zaida translates with a smile while Nelson laughs.
But after the surgeries, and the damage done to his face, Nelson says he feels depressed.
Prior to his surgeries, Nelson used to work in a restaurant.
"But because of his face," Zaida says. "He couldn't work there anymore."
So, Nelson began driving for Uber and Lyft, hiding his face behind a mask when picking up passengers. But even that came with difficult challenges.
"When someone calls a car service," Zaida translates. "When they see his profile, he explains there that he has cancer, and he can't speak properly. And that makes him really sad."
Nelson revealed to his daughter that people have even reported him to the ride-sharing apps because they thought he was on drugs, something he vehemently denies ever doing at any point of his life.
"I never even knew that," Zaida said. "Every time he would talk to us, he would say that he was doing great and he had five stars and all these trips. He wasn't really forthcoming about his struggles."
Nelson says he's shut people out of his life since his surgeries. He hasn't wanted to see his friends or even his brother.
"And that hurts him," Zaida translates. "Because that's his brother."
"Because he's not at the place," she continues. "Where he can socially be that person. Because he's scared they're going to reject him or humiliate him."
"I want to recover some of my self-esteem," Nelson says in Spanish. "Some of my personality."
Nelson's wife, Martha, was determined to find a solution for his struggles. And that's how they met Maddie Singer.
Maddie is a clinical anaplastologist with Medical Art Prosthetics, with 20 years of experience in creating medical and facial prosthetics.
Anaplastology is the artificial replacement of the nose, eyes, ears, or even fingers and toes, using materials such as silicone, blending artistry with modern technology to rehabilitate a patient's disfigurement due to cancer or trauma.
At her satellite office in San Jose, California, Maddie will meet with Nelson and Zaida, to create a new nose for Nelson and help him regain his quality of life.
"He's a little nervous," Zaida admits to Maddie.
"Don't be!" Maddie responds with a warm smile.
On the first day, Maddie explains the process to Zaida, who translates to Nelson, about what to expect over the next three days.
The first step is for Maddie to take an impression of Nelson's face, creating a "negative" with which she can create a mold of the area where his nose used to be. This will allow her to build a wax sculpture of Nelson's new nose, using old reference photos of him as well as her own artistic touch.
"Basically, we're the worst-case scenario," Maddie says. "You might go to a reconstructive surgeon who indicates to you that you might not be a good candidate. Either because of age, or the condition of the tissue. In which case, the alternative is to get a prosthesis."
As Maddie applies the compound to Nelson's face for the impression, Zaida calmly reminds him to relax and breathe slowly.
"People will either find Medical Art Prosthetics on the internet," Maddie says. "Or they'll hear it from a doctor. We have a long reputation, Medical Art Prosthetics has been around for about 40 years, now."
Greg Gion, the founder and owner of Medical Art Prosthetics, began his practice in Dallas back in 1985.
"Medical Art Prosthetics has kind of evolved," says Greg. "From a single solo practitioner in a very tiny office in Dallas to a national network of six anaplastologists."
These six anaplastologists are based throughout the country, with satellite offices in other regions as well, making them available to just about anyone in any part of the country with a little bit of travel.
"When a patient needs a prosthesis," Greg says. "We welcome them for three or four days. And in a very focused, concentrated approach, we do nothing else but work on that patient and focus on all the details that are needed."
"The wonderful thing about anaplastology is you have to be a science person, you have to be a problem solver, and here's the most important part: you have to want to work with people," says Maddie. "You have to be good at talking to people and making them feel good. They've had a terrible journey."
When the impression of Nelson's face is done, Maddie sends them on their way so she can begin creating the mold using dental stone. She packs the liquified substance into the negative space, and when that hardens, she'll have a replica of Nelson's face which she can sculpt over to make the custom prosthetic.
This is a technique Maddie is familiar with, because it's one that's been used in the film industry to create special effects makeup, something Maddie did professionally for over a decade.
"When I was a little kid," says Maddie. "Planet of the Apes' was on television, it was like the movie of the week. And I remember seeing those makeups being fascinated."
"And that's when I started doing facial prosthetics, myself."
Maddie would go to NYU film school, and upon graduating, she moved to Los Angeles and found herself working on movies and TV shows.
"I worked on a movie called 'Bicentennial Man,' Robin Williams played a robot," Maddie says. "I worked on 'George of the Jungle,' I worked on 'Species,' 'Species 2,' I can go down the list. It was really a remarkable ride working in special effects, I loved it."
It was in the early 2000s that Maddie happened to see a video of Greg Gion's medical facial prosthetics. After quick research, she says Greg's work was the best she had ever seen.
"I thought, 'This is amazing! I would love to do this! This is so up my alley!'" Maddie says.
So, she left the special effects industry to pursue anaplastology. She did her training at the University of Tennessee, where she spent 18 years, becoming the director of anaplastology. She ultimately left UT, taking a job at Roswell Cancer Center. After the pandemic, she connected with Greg and started working for Medical Art Prosthetics.
"So, I ultimately ended up working for the man who inspired me to get into this field to begin with," she says.
Back in her office, Maddie is busy pressing together large pieces of wax. With the help of sculpting tools and her training in forensic analysis, she builds a wax sculpture of Nelson's nose using only old photos of him she has saved to her phone. Think of it as a rough draft of Nelson's new nose.
"The reason we sculpt in a wax is so we can try it on," she said.
After carefully crafting the wax sculpture for several hours, Maddie welcomes Nelson and Zaida back to her office.
"Whoa!" Zaida exclaims upon seeing the wax nose perched on the mold.
Nelson examines his reflection in the hand-held mirror Maddie gives him, astonished at what he's seeing.
"It's not the final, Dad," Zaida explains to him.
"Seeing her start the process and just see how he lit up during that first experience that we had," Zaida says. "It was really special, I started crying, I felt really happy for him. Because I got to see, like, that glimpse of my dad. He was joking around."
"I'm really excited for him," she says as she wipes away tears of happiness.
"He has hope," Zaida says as she translates for her dad. "He's hopeful. He's really happy."
"This whole process has been really seamless," she said. "Dr. Maddie has been very helpful and really warm."
"He said he hasn't seen himself look normal in a really long time," Zaida says, translating for Nelson.
The following day, Maddie explains to Nelson and Zaida that she will be using the mold of Nelson's face to create the wearable prosthetic out of silicone. But first, Maddie must find the "intrinsic color" of Nelson's skin tone.
"Color-matching is critical, critical, critical," she said.
Matching the underlying color of Nelson's skin tone will ensure the prosthetic will blend seamlessly with the rest of Nelson's face. After some close inspection and tweaking the recipe, Maddie is able to make a small batch of silicone that is a perfect match of Nelson's intrinsic color. From this, Maddie will make a larger batch of silicone from which to create Nelson's nose.
"The work that we do as an anaplastologist," Maddie says. "Is art at the highest level of hyperrealism?"
"I treat it like 'Mission: Impossible,'" she continues. "How can I make something, that no matter what, is going to fool you all the time?"
Maddie admits that making nasal prosthetics is her favorite.
"This is completely creative," she says. "There's nothing there and it's right in the middle of the face. It's a really big challenge and it's incredibly transformative. So when I do it right, the person is so happy because they can finally move forward from what has held them back."
After about 15 minutes of curing, Maddie begins work on the intricate details that separate her work from her peers.
"That spatter, the natural spatter we have in our face," she said. "That's called mottling. We replicate the mottling, as well. Some people replicate the mottling in different ways, I do it in kind of an old special effects way. I actually use toothbrushes."
Maddie will dip a toothbrush into a pigmented solvent, and run her thumb along the bristles, spattering the solvent onto the prosthetic and creating natural-looking spots and imperfections.
On the third and final day, Maddie has Nelson and Zaida come back to the office one last time for the final try-on and finishing touches.
"What I want, once I have my new nose," Nelson says in Spanish. "Is to open the doors again to the people I have lost contact with."
"As an anaplastologist going on 20 years now," says Maddie. "What I've realized is that the prosthetic itself is kind of like a totem. It kind of represents everything that's preventing them from moving on."
"He says that he's happy," Zaida says, translating for her dad. "He's going to have this opportunity to show his brother that he can do it and he is going to overcome this."
"It's giving him his life back," she adds. "Dr. Maddie has been the only person that has been able to help him. He felt like a person again, he felt like someone worth something, and she made him feel that way. That he was worth being helped."
"Greg always says, 'you know, people forget, it's just a painted piece of rubber,'" Maddie says. "If you paint it right and if you sculpt it right, it transforms into something much greater than that. But ultimately, it's a painted piece of rubber. It represents everything they think is preventing them from moving forward with their life. And that's the catharsis of doing this process."
After some time adding details like blemishes and age spots, Nelson's new nose is indistinguishable from the rest of his face. As he looks at himself in the mirror, he can't believe what he sees.
"He says he has to get used to seeing his face again," Zaida translates for Nelson.
"Thank you, Maddie," Nelson adds in English.
As Maddie sees it, the field of anaplastology does need more high-quality people to assume its ranks. However, she feels the biggest obstacle is informing the public, and doctors in particular, that this option exists.
"The biggest issue I find," she explains, "is there are very few doctors who are very familiar with the level of prosthetics that are available."
"A lot of times I get the sense that they shrug their shoulders," says Greg Gion. "They don't know where to send their patient. And over the years, we find that there is actually considerable demand in the Bay Area."
As for Nelson, after getting a thorough demonstration from Maddie on how to properly wear his prosthetic using a special adhesive, he wears his new nose with pride. He feels as though he's been given a second chance at life.
"Thanks for giving him, the last years of his life, some quality," Zaida says to Maddie through tears.
"Everyone has their own approach," says Greg. "But Maddie seems to be able to do everything. From delivering a phenomenally artistic prosthesis to one that's user-friendly."
"To getting a big hug at the end of the process," he adds.
"I'm very proud of what I do, but I also take it very seriously," Maddie says. "And the relationships that I have with my patients are for life."
As Nelson and Zaida depart, they share one more tearful goodbye with Maddie, thanking her for the work she's done. The catharsis of this process extends well beyond the receiver of the prosthetic. It touches the loved ones of the recipients, fulfills the artist, and, hopefully, touches those who hear these stories.
For more information, visit Medical Art Prosthetics.