Facial and Ocular Prosthetics: Rebuilding After Surgery

What facial and ocular prosthesis involves

Maxillofacial prosthetics restore parts of the face lost to cancer surgery, trauma or congenital difference: a nose, an ear, an eye and its socket, a cheek, or a larger area combining several. These are custom-made silicone or acrylic prostheses, sculpted and painted to match the patient's remaining anatomy and skin tone, and retained with adhesive, spectacles, or implants placed in the facial bones. A facial moulage — a full impression of the face or a section of it — is the starting point, and has its own code. The prosthesis itself is then sculpted, fitted, coloured to match the patient's skin including its variation and translucency, and delivered.

When this treatment is used

Provided after resection of facial tumours, after significant trauma, or for congenital absence. This work is normally carried out by a maxillofacial prosthodontist or an anaplastologist working within a hospital or cancer centre team.

Why these are usually a medical rather than a dental claim

Facial prostheses are generally not a dental benefit. They belong to the medical side of the ledger — reconstruction following cancer surgery or trauma — and claims are normally submitted to the patient's medical insurer, often with a letter of medical necessity, the surgical history and photographs. That matters practically, because the amounts involved are substantial and the appliances need periodic replacement. Silicone discolours and degrades with sun exposure and cleaning, so a facial prosthesis typically needs remaking every two to five years — which is why replacement codes exist separately from the originals. Establishing the coverage pathway early, with the hospital team's social worker or financial counsellor, saves a great deal of difficulty later.

Costs and insurance in summary

Typical fee range across the group: $0–$0 where a single band applies. Several codes here are priced individually and carry their own range on their own page. Costs are substantial and highly individual. These are hospital-level prosthetic services and are normally pursued through medical coverage with a letter of medical necessity.

Benefit category: Medical / maxillofacial, variable on a typical plan. Rarely a dental benefit. Usually claimed through medical insurance as post-surgical or post-traumatic reconstruction, with documentation of medical necessity.

Common restrictions: Submit to medical insurance rather than dental in most cases; A letter of medical necessity and surgical history are normally required; Replacement intervals are limited — often every 2–5 years; Pre-authorisation is essentially always required.