The completed devices are held in place, Garcia explains, in one of three ways: by liquid adhesive, by a system of magnets attached to surgically installed metal posts (as in Wood's case), or by metal clips secured to strategically placed hooks (the best and most expensive technique), depending largely on how much bone is available for use.
A prosthesis costs between $3,500 and $10,000; because it's classified as durable medical equipment, Medicare or private insurance generally picks up much of the tab. The patient removes it at night to clean it, reinstalling it next morning.
Invariably, in the last photo on the right, you can see the outlines of a prosthesis if you look carefully, but you also see an altogether unexceptional human face gazing out.
In a situation like this, normal is the miracle.
"All my friends and family were aware I had a prosthesis, since all knew of my operation," writes a patient whose letter Garcia includes in the binder, "but all were amazed at how much my new nose looks like the original. One remarked, 'He even got the bump on your nose right!'"
"Thank you for making me a new ear," writes another patient, an 8-year-old boy. "It looks more real than the ear I had before. Nobody at school noticed it changed. By the way my soccer team is still undefeated!"
Seeing those photos in 2002 told Wood and Palen volumes about a field they — like many doctors, let alone patients — had never heard of, giving them hope they could face the unknowns ahead.
Garcia made Wood's first prosthesis that year, over six office visits. Because they last only between one and five years, he made her another in 2007. On a fall day four years later, she has made the long trek from Delaware to receive her third, Palen in tow.
The process of making a prosthesis has so many facets that Garcia tells patients never to expect perfection. He's attaching rubber to surfaces that move; each patient's tones and textures are unique; much depends on his artist's eye; and he has his good and his bad days.
But as Wood enters, even as he greets her, he's searching her face with the intensity of someone after the ideal. What he sees is a device whose seams have loosened, that has darkened with age and needs replacement.
Garcia teaches, travels widely and conducts research — and now supervises one or two students at a time in a new clinical anaplastology training program — but he spends so much time making these devices that it amounts to a full-time job.
Just as he did in 2002 and 2007, he has been working hard in his studio to get her replacement ready. The process began two weeks earlier.
The first step was for Garcia to cover the entire affected area with a plaster material in order to make a cast. (Because Wood lacks a nose and cheek, he borrowed Palen's as a model.) He then filled the cast with hot wax, creating a three-dimensional replica. He adapted the nose to that sculpture, creating a total structure called a mold.
Next he cast his portraitist's eye on the healthy part of Wood's face, scrutinizing it for color. He mixed a range of five tones that, when interwoven as silicone paint, could re-create her skin tones in all their variety. Over the course of hours, he added those pigments to the mold, bringing it somewhat to life for the first time.
Finally, he baked the piece in an oven overnight to cure it. When he removed it next morning, its colors and contours evoked Wood's face, at least to his naked eye. But he still had a perfectionist's case of nerves. You don't know how good a match it is until delivery day.
Lead me to your door
Back in college, just after he'd switched to art, Garcia says, a professor gave him a task: Pick a Beatles song, then use any visual medium to illustrate it.
He chose "The Long and Winding Road," a tune he always felt describes a journey of the spirit. He found himself painting the image of a wooden gate with lights streaming out from behind, as though concealing a glimpse of heaven.
Then Garcia, as devout a Catholic as his father was, crafted a bust and placed it right in front of that image, its facial features contorted in agony.
"I think it was that whole idea of living in an imperfect world, straining for that perfection beyond," he says.
Today, Garcia adds, it gratifies him to use all his skills helping patients do just that, if only in a small way.
As Wood takes her place in the dentist's chair, she lets him unclip the old mask, revealing a hole in her cheek nearly the size of a baseball and a chasm where her nose should be. He clicks the new one in place.
The observer sees a mask that looks good, a cleaner match than what she came in with. Garcia sees hues that are "too cool" — so much so that he's unsure whether he can fix them.
Eyes set, he seizes palette and brush, dabs into a range of pigments, and using pinpoint strokes, slashes yellows, umbers and reds onto the piece as though working on an easel.