This is a 3D print of Mr J.F. Lian. He lost part of his nose to skin cancer in 2022 and now, thanks to 3D printing, he’s got a new one.
The team at the Medical 3D Printing Centre at Tan Tock Seng Hospital (TTSH) scanned Mr Lian’s face before he went for his operation. With that digital model, they could begin resculpting his nose digitally.
It was the first time TTSH was making a custom-made 3D-printed nose for a patient, and it took several trials and iterations to get it right.
Among the factors the team considered was the weight and material of the prosthetic nose. Most importantly, the nose had to be comfortable for Mr Lian to use.
They tried using a nose clip to attach it to his face, but it turned out to be uncomfortable for prolonged use.
They also had to make sure the nose fit well. At some point, earlier iterations of the nose model no longer fit Mr Lian’s face well, as his wound had become smaller.
On March 7, 2023, after nearly four months of fittings and redesigns, Mr Lian walked out of the hospital with a bright smile on his face, wearing a nose reconstructed from skin-friendly resin and hand-painted to match his skin.
How Tan Tock Seng Hospital built a cancer survivor a 3D-printed nose
Mr Lian’s was the first prosthetic nose created by a team of doctors and 3D-printing engineers that has been pushing medical boundaries at TTSH.
Leading the team behind this ground-breaking project was Dr Michael Yam, an orthopaedic surgeon and head of TTSH’s Medical 3D Printing Centre that officially opened in November 2022.
The centre prints models of patients’ organs from medical scans to help doctors better explain conditions and treatments to patients. Engineers from Medairum are seconded to the centre to deal with 3D printing jobs. Medairum, which specialises in medical 3D printing, was one of the companies licensed to manufacture 3D-printed Covid-19 swabs during the early stages of the pandemic.
3D printing a prosthetic nose for Mr Lian was a pilot project for the centre. They designed the prosthesis to look practically identical to his original nose.
“When he had his final fitting, I felt so satisfied because it felt like I was returning something to him,” said Dr Yam, who has been experimenting with 3D printing technology since 2019.
I felt so satisfied because it felt like I was returning something to him.
“It was very fulfilling to see Mr Lian happy wearing the nose and being comfortable not wearing a mask,” said Medairum general manager Nirodha Ariyaratne. “Although there were challenges in getting the fitting right, once that finally came into place it was very fulfilling for me.”
The success of this pilot project paved the way for other custom-made prosthetic projects for TTSH’s 3D printing centre. Since then, TTSH has also worked on two other major projects - a functional finger prosthesis and a cranial cap.
Prostheses or artificial body parts can help patients regain both function and self-confidence.
The recipient of the functional finger is 21-year-old Russel Ko, who lost his finger in a road accident in 2022. The prosthesis restored his ability to perform daily activities and allowed him to “feel normal” again.
The team also created cranial caps for patients awaiting skull reconstructive surgery after having a portion of their skulls removed following a stroke or accident, worn to protect the brain.
The designs of 3D-printed prosthetics are tweaked based on each patient’s requirements.
Mr Lian’s nose prosthesis required more than seven iterations. The nose model may sit perfectly in computer modelling, but may not fit well in real life, explains Dr Yam. The team took pains to test if the nose was comfortable for Mr Lian to use for longer periods, and how it sits when he moves or does various activities.
The team experimented with different materials. They wanted something biocompatible, so that the 3D print would not cause any skin allergies or toxic effects. The material also had to be certified by regulatory bodies like the United States’ Food and Drug Administration and the Health Sciences Authority in Singapore. Given these considerations, they settled on using a surgical guide resin, which is typically used for dental prostheses.
The final product was a 12g prosthetic made of surgical guide resin. Here’s how it was printed.
The 3D-printing technique used is called stereolithography, which builds up a structure layer by layer using a liquid resin that hardens when exposed to UV light. Printing Mr Lian’s prosthetic nose took about an hour.
Next, the 3D print is taken out of the printer and soaked in isopropyl alcohol to remove excess resin.
The 3D model is then put in a curing machine, where it hardens under UV light.
Finally, it goes through trimming, sanding and polishing before it is ready for painting.
The next hurdle? Getting the 3D print to match Mr Lian’s skin tone.
The team roped in cosmetic experts - Ms Jessie Goh and Madam Ho Ee Na - from the Institute of Technical Education (ITE) for this challenge. Ms Goh, who is the section head of the beauty and wellness course in ITE College East, has years of experience doing stage and special effects make-up. However, painting a prosthesis was new to her and she worried whether she would be up to the challenge.
“The kind of work we do is meant to last only a few hours or a day, but this nose is for daily use,” said Ms Goh.
The duo met Mr Lian five times at the Medical 3D Printing Centre to work on getting the right skin tones, mixing layers of skin-safe acrylic paint to get a light beige colour that matched his face.
“It’s very different,” said Madam Ho. “When we do make-up, we blend colour on a person’s skin. The paint sits very differently on the prosthetic nose.”
Their efforts paid off. ITE College East is now a partner of TTSH’s 3D printing centre, to provide cosmetic services for its prostheses.
The college is planning to add these projects to its existing curriculum, where students from its beauty and wellness course can work on future 3D-printed prosthesis. “We want to tell them that as a make-up artist and with the skills that they learn, they can actually help people to gain back their confidence,” said Ms Goh.
Ultimately, the long term goal is to scale up and make medical 3D printing mainstream in Singapore.
3D printing can be a solution to many medical problems, said Dr Yam. “We want to make 3D printing more accessible to patients.”
The next step for the centre is to look into a pricing model to make these prostheses available to patients who may need it. This will also allow the centre to be sustainable in the long run. One consideration for costing is ensuring that it can be subsidised, just like other orthotics and prosthetics.
Despite TTSH’s success in Mr Lian’s case, Singapore still has a long way to go in medical 3D printing. There are higher fidelity types of 3D prints, such as implantables and customised plates, that TTSH has yet to explore.
“We want to become the standard of care and we are trying to emulate what Mayo Clinic is doing in the US,” Dr Yam said, referring to the non-profit American academic medical centre’s forays into 3D printing. “One day, we would like to be able to replicate its 3D printed point-of-care implantables capabilities as well.”
Medairum’s Mr Nirodha added: “You also need the regulatory bodies to come in and really set down the landscape for this technology adoption. All kinds of regulations need to be in place, and certifications need to be in place so it becomes a safe technology to be used on patients. It’s currently happening.”