Britain: When restaurant manager Eric Moger surprised his girlfriend by proposing over Christmas dinner, he could have no idea that less than a year later his life and appearance would be changed beyond recognition.
As he started to make plans for his wedding to Karen Hunger four years ago, doctors discovered an aggressive tumour the size of a tennis ball growing beneath the skin of his face.
Emergency surgery to deal with the cancer removed almost the entire left side of his face, including his eye, his cheek bone and most of his jaw, leaving a gaping hole where his features had once been.
Now, after years of having people stare and recoil at his disfigurement, surgeons have employed cutting edge three-dimensional printing technology to create a prosthetic face for Mr Moger, 60, in what is thought to be the first procedure of its kind in Britain.
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By making scans of what was left of his skull and using computers to recreate what his face would look like, they were able to use a new type of printer that builds up layer upon layer of nylon plastic to produce the components they would need.
The prosthetic face has transformed the father-of-two's life, allowing him to drink his first glass of water and taste food for the first time since he underwent surgery to remove the tumour. Until now he has had to eat and drink through a tube directly into his stomach.
"I was amazed at the way it looks," said Mr Moger, who lives in Waltham Abbey, Essex, with his fiancee. "When I had it in my hand, it was like looking at myself in my hands. When I first put it up to my face, I couldn't believe how good it looked.
"Before, I used to have to hold my hand up to my jaw to keep my face still so I could talk properly and I would have liquid running out the side of my face if I tried to drink.
"When I had that first glass of water wearing the prosthetic face, nothing came out - it was amazing."
Three dimensional printers were developed by the manufacturing industry to produce prototype components quickly.
Dyson, the vacuum cleaner and technology company, has made extensive use of them in research and development, but they have rarely been employed in medicine.
Andrew Dawood, a dental surgeon and implant specialist, began using 3D printing a couple of years ago to help produce replicas of his patient's jaw bones so he could practise surgical procedures.
Mr Moger was referred to him by Nicholas Kalavresos, a surgeon at University College London Hospital who carried out the life-saving but physically devastating work to remove the tumour.
Attempts to use standard plastic surgery to rebuild Mr Moger's face had failed because of the chemotherapy and radiotherapy he was receiving. Instead, Dr Dawood used detailed scans to build up a 3D image of the bone left in Mr Moger's skull and of his facial features.
Dr Dawood said: "We put the CT scan and facial scan together and used software to plan what we wanted him to look like."
The scans allowed Dr Dawood to design a "scaffold" to replace the missing bone, created from titanium using a technique known as 3D milling, where a piece of metal is cut into shape by a computer. Screw-like 2-inch long rods were also made in a similar way before being surgically implanted into the remaining bone on the right side of Mr Moger's face, allowing the scaffold to be secured in place.
A plastic plate was also created using a printed model of his skull to help form a seal at the top of his mouth, allowing him to eat and drink again.
Computer software enabled Dr Dawood to create a mirror image of the right side of Mr Moger's face and using 3D printing he built up a facial shell made of toughened nylon.
This was used to mould the new silicone mask that would cover the hole in Mr Moger's face, using magnets so it can be secured in place and removed easily when Mr Moger goes to bed.
Dr Dawood now hopes to develop new techniques to allow them to print the silicone mask, which would help speed up the process and allow patients to have access to replacements rapidly.
He said: "At the moment we cannot print silicone itself, but there are some new machines appearing in industry that print a silicone-like material, so we are hoping to do this in the future.
"It would mean we could produce different types of prosthesis for people, like one with a tan for when they go on holiday, but we are not there yet."
For Miss Hunger, her fiance's new face has raised hopes that they can soon return to the normal life they once enjoyed.
Mr Moger was a keen angler when he was not working at the Marriott Hotel in Waltham Abbey, where he was assistant restaurant manager, and the pair enjoyed regularly eating out and going on long walks in the countryside.
Miss Hunger, 48, said: "The first time I saw him after the surgery it was a big shock. You get used to seeing the whole person, but suddenly he had a big hole where other things should have been.
"He does wonder why I am still here and want to get married to him, but when you love someone you love all of them.
"Now he has got the prosthesis, it looks so lifelike. I don't know how they have done it, but it really does look like him. When he puts it in, he has his whole face back. We have been in limbo for such a long time now, so we are hoping to get some sort of life back."
With new confidence and the new face staring back at him in the mirror, Mr Moger, who has two daughters and three grandchildren, is now turning his mind back to a promise he made on Christmas Day five years ago. He has a wedding to plan.
"We are still going to get married when this is all sorted out," he said. "I am going to get some new teeth fitted which means I can chew again too, but after that I am looking forward to getting married and restarting my life.
"Now I have a new face for the wedding I can restart my life after having it on hold for four and a half years."
The Telegraph, London
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