Artificial limbs have several vital functions. Each of these vital functions will be assigned a relative importance by the amputee who uses the limb. For some, the vital function may be to allow them to run as fast as possible to win races. For others, it may be to allow them to hold an object still so that they can work on it easily. For many, one vital function is to restore, as closely as practical, the appearance they had prior to the amputation.
Few would argue that restoration of the ability to walk or hold something is a requisite function of an artificial limb. Unfortunately, some insurance carriers have argued that any aesthetic restoration is unnecessary and that “cosmetic” covers are not reimbursable under their policies.
For the amputee to be told that the insurance will only provide function is completely inappropriate, unfair, and denies the validity of body image as a part of mental health and emotional recovery. Historically, prostheses were only considered functional if they enabled individuals to perform physical tasks, permit the body to move, or enable any number of active functions not previously capable without a prosthesis. This perspective has changed over the years and many health care providers now recognize the functionality of cosmetic prostheses, in addition to recognizing their incredibly high rehabilitative success rate; however, the industry still has a long way to go.
Strangely, a great prejudice against “cosmetic prostheses” is caused by their description containing the adjective cosmetic. When one reads or hears the word cosmetic, the first association quite often is with women’s cosmetics (make-up). By many, cosmetics are seen as frivolous, unnecessary, and vain. In the case of someone with a facial deformity or loss of a facial part, such as an eye, the cosmetic restoration takes on a very different role. It would certainly seem cruel to inform a person missing an eye that an eye prosthesis is not medically necessary because it is cosmetic. Should they have a non-cosmetic eye made out of wood or metal not looking like an eye at all? Would it then become medically necessary because it is not cosmetic? Of course not — having the prosthesis look like an eye is the main reason for having the prosthesis created.
It is extremely important to teach all insurance carriers that appearance is very important to every amputee. It is a vital function of the prosthesis just like standing, walking, holding, and balance are to the amputee. Some amputees may choose the rugged, “black pipe” look, which is popular with many young athletes. Some may choose a very life-like aesthetic look with toes, skin-like covers and perhaps even hair on the leg or arm. Some may choose the exoskeletal prosthesis with the virtually indestructible outer shell. Finally, some may want to change the look just as they change clothing to fit their activities. The strong message needs to be that it should be the choice of the amputee — not the decision of some insurance company clerk or benefits manager.
Modern cosmetic or aesthetic prostheses are more life-like, durable and functional than ever. Even the most realistic hand cover today can be made as durable and functional as the “department store mannequin” looking hand prostheses of 20 years ago. Interchangeable terminal devices allow the quick change from the highly realistic hand with silicone glove and fingernails to a hook or pincher terminal device for rough work or precise prehension.
Interchangeability and adaptability are the rule rather than the exception. The covers for lower limbs can be highly realistic, durable, and removed for more active pursuits. This allows the active amputee to modify the limb quickly to meet the needs of the day. An amputee who wants to appear symmetrical in shorts on the golf course can leave off the cover to work in the garden or yard. A runner can shed the extra weight of the cosmetic cover for running and don the cover to wear with a dress to a dance the same evening.
The most important message is that ability to choose appearance is a right of the individual amputee and should not be determined by an insurance company, physician, prosthetist or anyone else. The opportunity to have and use an aesthetically pleasing “cosmetic” cover for a limb prosthesis is a valid, essential, functional element of the prosthetic restoration. It should not and cannot be relegated to the status of an optional item since it plays a vital role in the true function of the prosthetic limb.
About the author
Michael D. Kaczkowski is the founder and president of Aesthetic Concerns Prosthetics, Inc. As a fine artist, Mr. Kaczkowski has been striving to mimic the appearance of human skin for over 14 years. As a clinician with nearly 10 years of experience fitting amputees with cosmetic prostheses, Mr. Kaczkowski’s company custom fits their LIVINGSKINÆ prostheses for amputees all over the world.