Creating Natural Form Restorative Art Theory and Application

Benjamin Schmidt Sean Sweetman Briana Garcia

Illustrations by Cassandra Springborn

Contributing Editors: Steve Dawson, Owner Sax Tiedeman Funeral Home and Monarch Cremations Damon de la Cruz, PhD, Associate Professor Cypress College Robert Holmes, PhD Barry Lease, EdD, Program Director Pittsburg Institute of Mortuary Science Timothy Kowalski, MDiv, Instructor Worsham College of Mortuary Science Leili McMurrough, JD, Program Director Worsham College of Mortuary Science Karen Scott, MBA, Program Director Malcolm X College

Interior Design: Heather Braatz Cover Design: Amanda King and Cassandra Springborn

All rights reserved. When forms and sample documents are included, their use is authorized only by educators, local school sites, and/or noncommercial or nonprofit entities that have purchased the book. Except for that usage, no part of this book may be reproduced or utilized in any form or by any means, electronic of mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Printed in the United States of America.

About this book

This book is here to provide a resource to both students and practitioners alike. In addition to classic restorative art techniques, this book addresses and expands upon:

• Dressing and casketing

• Unembalmed bodies

• Use of real-world case studies

• Incorporation of embalming science into restorative art

• Human anatomy

• Pathology and its effect on restorative art

• Cosmetics

• Color theory

For more information about this book, please contact us at: [email protected] @mortraqr on Instagram and Twitter www.tuesdayeveningpublications.com

To Arian, Clementine, Grayce, Paige, Ryne, Will, and anyone who comes after. This book is proof your parents are cool.

CONTENTS

Section I From Here to There 1. Getting from Here to There ...... 1 2. Types of Restorative Art and Case Considerations ...... 8 3. Tools of the Trade ...... 14 4. Building a Base ...... 20 5. Bones ...... 23 6. Muscles...... 34 7. Skin and Its Markings ...... 41 8. Our Feature Presentation...... 50 9. EveryBODY Is Different ...... 82

Section II Two Sides of the Same Coin: Embalming and Restorative Art 10. Preservative Art ...... 121 11. The Prep Room Detective: Investigating the Case ...... 131 12. A Little Bit of Pleasantry: Setting Features ...... 140 13. Keeping an Eye on Things: Monitoring Your Injection Procedure ...... 156 14. Incision Closure ...... 172 15. Autopsy Preparation...... 184 16. Organ and Tissue Donation ...... 193

Section III What Comes After: Post Embalming Treatments 17. Tissue Building ...... 199 18. Compresses ...... 210 19. Waxes and Their Application ...... 212 20. Tissue Damage ...... 217 21. Case Studies ...... 239

Section IV The Final Puzzle Piece: Presentation 22. Can You Make Him Look Like this Again? The Value of Photographs ...... 264 23. Color Theory ...... 274 24. Lighting ...... 278 25. Cosmetics ...... 288 26. Natural Recreation ...... 317 27. Haircare ...... 327 28. Laying Facial Hair by Hand ...... 333 29. Ready for Their Final Party: Dressing and Casketing ...... 342 30. Preparation of Unembalmed Bodies ...... 355

Glossary ...... 360 List of Figures ...... 367 Index ...... 370 Author ...... 380

I From Here to There

“If we knew what it was we were doing, It would not be called research, would it?” —Albert Einstein

1. Getting from Here to There Objectives  Describe an overview of restorative art

 Discuss the objectives of restorative art

 Distinguish different restorative art procedures and how they relate to the embalming process

onsider the photographs above. still require tools in your restorative art tool C These images are the before and box. The scope of this text is to equip you after pictures of a person who died of with some of these tools before you begin a gunshot wound as featured in Case 1. They gaining the experience you will need to are just two pictures, but there is a lot of a become an effective restorative artist. If these knowledge and experience in the space tasks seem daunting at first, that’s okay. between them. This is knowledge and experience that you too will gain throughout We define restorative art as the care of your career as an embalmer and a restorative the deceased to create natural form, color and artist. However, trauma such as this only texture. However, philosophically it is much represents a small portion of restorative art. more than that. In order to become good You will engage in restorative art in some restorative artists, we need scientific manner from the moment you caringly place thinking, community engagement, and the the individual on your embalming room table willingness to try new things. First, scientific to the moment you place them in the ground thinking comes from everything from or crematory. Even if the person is not to be understanding human anatomy, to using embalmed, simply viewed privately by the color theory. Second, one of the most family before burial or cremation, you will beautiful parts of restorative art is that it is a

1 Section I: From Here to There community event, meaning that one gains them, but the goal is to put them in a knowledge through technical learning and restorative art context for you. experience as well as conversations with their fellow embalmers. Third, we must be willing Building a Base to try new things. Through both scientific In order to get from here to there, we will thinking and community engagement, we will start with anatomy. First, we will start with be given new ideas and products to try. terms that describe anatomical directions Please do that, so you can pass your and planes. After that, the fun begins with a experience on to others. That having been brief primer in Latin (bet you didn’t expect to said, let’s look at your pathway from picture learn a new language when you picked up this one to picture two. book did you?). Learning the translation of commonly used Latin words in to English will better help you identify different anatomical Section I: From Here to There structures, how they are shaped, and where they are located. From there, we will examine Case Considerations and Types of the skull and its importance to restorative art. Restorative Art We will explore each bone and their significant land marks individually. After our brief introduction from above, we need to identify what exactly restorative art is We will explore each bone individually and and where it comes from. The pictures that significant landmarks you will need to be were introduced to you illustrate what you aware of. You will find that is not only useful may already understand about restorative to have this knowledge in cases of a large- art, for example that is performed when scale restoration where bone is damaged, but someone suffers trauma. However, it is much in cases of every day restorative art to better deeper than that. Restorative Art is also locate and align different structures. We will necessary when it comes to: discuss gender differences in skulls, how aging effects them, and a brief history of • Pathology and the disease process skulls and race. Then, we will consider the • Age next layer up: the muscles. We will review how muscles are named, where they are • Postmortem changes located, and what they do. Having this • Effects of embalming information will give us a better understanding of how they affect surface The next thing we need to do is categorize form and facial markings. Finally, we will different types of restorations. This is look at the outer layer; the skin. Obviously, important to understand because when faced this is the part that everyone sees, so we need with an issue, you need to know how to to be very sensitive to understanding it. We communicate with the family, and in some will cover the different types of tissue in your cases, ask permission to conduct a skin, how it is colored, the different layers, restoration. You will see that the simpler and discuss hair. After that we will learn procedures are often integral and take place about the different pigmentation anomalies during the embalming procedure, while and how to work with them both technically others have broader scope. and when communicating with a family. Tools of the Trade Further, we will talk about the types of facial markings we all have, whether we are born Before you begin any job, it helps to know with them or acquire them over time. what type of materials you will need and when to use them. In this chapter, we will Our Feature Presentation have this conversation and give you a few a Here we will discuss each of the four facial few examples of how they work in practice. features individually. Knowing the landmarks You may already be familiar with some of 2 Creating Natural Form and parts of each one will help us to have immediately goes to the traumatic head better calibrated eyes when doing things like injury or the loss of a limb. However, as setting the features and tissue building. We funeral directors, it is imperative that we will also discuss how to construct a feature shed this mindset, recognizing that the from scratch using a geometric process much restorative art process begins at the same like that a sculptor uses. time your embalming case analysis does; the moment you set eyes on the deceased This will help you in your classroom and in individual. In Section II, we start what is your embalming room. You can even look for going to be a reminder of an on-going a checklist of items to review to make sure process. you have all the necessary characteristics. Facial features also often require individual Before we look at the different chapters in restoration in different ways, which we will Section II, let’s take moment to generalize explore here. this process from start to finish to have a better understanding of how restorative art EveryBODY is Different fits in. Consider these steps: Once we have a good understanding of the 1) Washing the body anatomy, we can start to put it into practice. First, we will use structures on the head and 2) Setting the features face to ensure we are aligning everything 3) Vessel selection/place of incision properly. Next, we will look at the different head shapes, the differences in people’s 4) Selecting the appropriate embalming profiles, and how they exhibit different fluids and solution mixture bilateral curvature. Then, we will divide the head in to different fractional measurements 5) Monitoring the injection process to create regions where we can expect to find 6) Performing the appropriate incision different structures of the face. Finally, we closure will review the face as a system, and how it ties together both vertically and horizontally 7) Washing the body by comparing the locations and sizes of the 8) Post embalming techniques and facial features in relation to each other. monitoring 9) Cosmetics Section II: Two Sides of the 10) Dressing the body Same Coin 11) Placement in the casket When it comes to Restorative Art, it begins with embalming. The two are so closely If you read through this list and think to intermingled in many cases, that to have a yourself, “this sounds like my embalming memory picture that will help to soothe a process,” your embalming teacher would be grieving family, you must have both. A good thrilled with you, as you are exactly right. As embalming is excellent, but it is restorative mentioned above, the restorative art will art that makes grandma look like grandma always go hand in hand with embalming. again. On the other side of the coin, while it is Now, let's look at each one of these steps and possible that you can create a natural get a better description of how restorative art memory picture without embalming through is taking place. the use of cosmetics and proper feature Washing the body. When individuals die, setting, it is short lived and depending on rarely do they look ready for their final your case, can be risky. farewell with their family. By washing them, When the general public thinks of we can get a better feel as to what this person restorative art, perhaps their mind looked like on their best days. Furthermore,

3 Section I: From Here to There often time features are obscured by body low-cut dress. If it’s a man, expect him to go fluids, unkempt hair, or medical devices. in a tank top. This means that you should take care in not only choosing which suture Setting the features. As part of our to use, but how you execute it and ensuring embalming process, we close or “set” the its dryness with the expectation you will have features. However, from a restorative art to wax and cosmetize over it. perspective, it is how they look once they are closed that we are concerned with, and if they Wash the body (again). Embalming can be are not closed properly, that we are going to a messy procedure. In order to get the correct do to fix them. look before performing any post embalming restorative art, we must have a clean and dry Vessel selection. Vessel selection is surface to work with. Furthermore, it important to restorative art in the sense that wouldn’t make sense to perfect any we must get proper solution distribution and restorative art and then have to wash the diffusion to areas for preservation purposes, person afterwards. keep in mind the incision maybe visible. Even the common the carotid artery can be Post-embalming restorative art exposed depending on the type of clothes an techniques and monitoring. This step is a individual will wear in the casket. In some vague allusion as to what you may need to do situations, we may need to raise a facial or between the second washing and cosmetics. radial artery, resulting in a necessary cover This is for good reason, as Section III of this up. Further, making the decision to raise book is dedicated to your options during this multiple vessels during the embalming step. process can only serve to give us better solution distribution and diffusion. Cosmetics. The skill and ability to choose and apply cosmetics is a learning process Selecting the proper fluids and solution every restorative artist participates in until mixture. As embalmers, we have three the end of their career. In the scope of this objectives; preservation, disinfection, book, techniques and choices will be offered and restoration. We should instead be as a baseline for decision making and further thinking of it as disinfection + preservation = exploration throughout your career. restoration. One might think that as restorative artists, we are focused on the Dressing the body. What looks more restoration function. Nothing can be further natural than a man laying down in his full from the truth. In later chapters, we will see military dress uniform? How about a woman the importance of remembering the first two in her wedding dress? The answer is literally in order to produce the proper restoration. everything looks more natural than these. Remember; even the best dyes and cosmetics However, dressing is part of the restorative will not stop the decomposition process. art process, just as much as cosmetics or rebuilding trauma. Monitoring the injection process. Of course, we have to keep an eye on what’s Placement in the casket. The final step in going on with the body if we want it to look restorative art before the family sees the body good! As restorative arts, we can expect to is that final, natural way the person in your have to adapt quickly to new changes with care is to look in their casket for viewing. the people in our care. No situation during Managing the subtleties of the way that the restorative art process is more sensitive person looks can be the icing on your to change than the injection of the restorative art cake. embalming solution. We address several of these steps in Performing the appropriate incision Section II: Two Sides of the Same Coin. closure. This step is best done with the prediction of the worst-case clothing scenario. If it’s a woman, expect her to go in a

4 Creating Natural Form Preservative Art Decomposition. Decomposition is a long process and we will be faced with it in various An important part of the restorative art stages. However, this does not mean that we process is how it relates to the selection of will have to tell a family their loved on is embalming fluids. However, before we decide unviewable, quite the opposite, many of these what embalming fluids to choose, we must problems are solvable. understand why we choose them. This starts with the recognition or what is happening in Pathology. Understanding disease process is the chemical environment in the body: very important to us. When a person dies of a certain pathology, it can instantly give clues • Proteins and how formaldehyde preserves on what to expect. Here we examine a few of them the more common causes of death and what • pH and how it is affected by chemical they mean to us. reactions A Little Bit of Pleasantry • Bacterial activity and outcomes An important part of the way people look is • The role temperature plays well… how they look. Specifically, how their mouth and eyes are closed. In this chapter we • The importance of recognizing moisture will discuss your different options for this and how to balance it and examine some different difficulties you might face and how to trouble shoot them. Also, we consider decisions made in the Embalming Chemicals grooming and the placement of hands. Besides formaldehyde, there are several other Keeping an Eye on Things chemicals the modify or supplement the action of formaldehyde, such as: Earlier when considering case considerations for Restorative Art, we mentioned that • Buffers to balance pH restorative art caused by the embalming was a potential issue. Here we examine ways to • Surfactants to decrease surface tension identify and react to issues such as vascular • Humectants to retain moisture resistances, swelling, dehydration, and miscellaneous. • Anticoagulants to break up blood clots Incision Closure We also will gain an understanding on how preservatives other than formaldehyde will Once the injection phase of your embalming help create the best possible memory picture is over, you will be left with different for the family. incisions, or as we will discuss later, the outcomes of trauma or surgery. Different The Prep Room Detective tissue conditions will require different Once we have discussed what is happening in actions, and here we will give guidance on the universe beneath the microscope, we can what they are, how they work, and how to use look at what we see when exposed to a new them. case, and what it can tell us is happening and Autopsy Preparation of course how we solve it: The preparation of an autopsied body Long-term care. When some in is long term presents a new set of challenges to the care because they are sick or aged, there are restorative artist. It is a very disruptive outcomes of the use of drugs, the way process to both the head and torso, that moisture shifts, and the weakening of effects the way people appear in their casket. muscles. Here we discuss how to preserve and present the autopsied case. Furthermore, in Section

5 Section I: From Here to There III we will examine real life cases, several of Tissue Damage which include an autopsy. Now we must address some of the most difficult emotional and technical challenges Organ and Tissue Donation of our careers. Tissue damage comes in many forms and varies from person to person. The Like an autopsy, organ and tissue donation outcomes are often unpredictable; however, can be a disruptive process. However, we can give you some insight on how solve donation is an important part of society and problems pertaining to: the choice of many families. In order to meet • Abrasions those family’s needs, we discuss the different types of long bone and tissue donation and • Gashes how we can be better prepared to work with • Incisions the donors. • Burns

• Fractures Section III: What Comes After — Post Embalming Treatments • Mold • Gunshot wounds In Section III, we will explain restorative art treatments that come after your embalming • Sharp Force Wounds is completed. As you will learn in your career, • Dismemberment sometimes this is very simple and sometimes very emotional and complicated. • Decapitation Tissue Building Furthermore, we also must discuss different types of skin pathology and how to One of the most basic and common apply restorative art techniques. We Here we techniques any embalmer uses is tissue look at some of the more common skin building. In this chapter, we will explain the disorders, encourage a discussion with the different types of tissue building chemicals, family, and how to fix them. the general procedure, hidden points of entry and when to tissue build. Case Studies Compresses Finally, before we go, we present you with ten real life case studies for your consideration. In Tools of the Trade, we briefly discussed Some of them have been solved, some we what and compress is for and how to use it. leave you to draw your own strategies and Here we take a much more in-depth look at conclusions. the different types of compresses, their application, and when to use them. Waxes and Their Application Section IV: The Final Puzzle Piece; Presentation Passed this chapter, the rest of this section begins an in depth look at how to solve many We finish the book with how you can present restorative art considerations such as trauma your person to their family. You have labored and pathology. This involves the use of waxes through everything we have already in many cases, so before we begin those discussed, and it’s time to show them how discussions, we must have this conversation. much care you have put into this process. In this chapter we will look explain the different types, their application, and how to heat, cool, and color wax.

6 Creating Natural Form Can you make him look like this • Placement in the casket again? • Finishing touches In this age of technology, every person should Preparation of An Unembalmed Body be accompanied by a picture. The accessibility is so ubiquitous now that we Before we go, we must make sure that we carry cameras in our pockets. Not every are helping all of our families, including those picture is created equally and here we discuss who do not wish to embalm their loved one. the differences in photographic viewpoints, This does not mean that we cannot present styles and, types. them for viewing. This chapter will remind you on how to do this safely, cleanly, and Color Theory advise you on the procedure for preparing, Seems pretty basic, but don’t underestimate dressing and cosmetizing them. color theory and its use in restorative art. We Does all of this seem like a lot? That’s will define different terms, where it comes okay, because it is. Remember our woman from, and how it can be manipulated to serve from the beginning of the chapter? Some our purposes. element of all of these was included in her Lighting reconstructions. Let this be your first understanding of how important this process This is the first reason we need be sure we is. However, don’t be intimidated. This text have a grasp on color theory. Lighting plays will start you down the correct path, and you an important role in how we cosmetize and will gain much experience and knowledge as present decedents in the funeral home and you continue to practice. Now let’s get other locations. Here we describe the started! different types of lighting and the effects of colored lighting on objects. Cosmetics Concepts for Discussion Cosmetics are the second reason we must 1) How do the steps of the embalming understand color theory, as we must choose the right color for the right skin tone. We also procedure relate to restorative art? discuss different types of cosmetics, different types of brushes, ways to create natural skin 2) How does the embalmer’s mindset color, and contouring. affect the way he or she complete their Haircare embalming tasks in relation to An important part of restorative art is the restorative art? presentation of hair, both on the person’s 3) Describe the importance of anatomy in head and face. In this chapter, we discuss how to care for hair, wigs and hair pieces, restorative art. how to restore damaged facial hair, as well as ways to curl and color hair. Dressing and Casketing Now we have reached the point of dressing and placing the person in the casket. This chapter describes tips and techniques for doing just that:

• Placement of clothes

7 Section I: From Here to There

5. Bones

 Classify cranial and facial Bones

 Identify skull sutures

 Differentiate between male and female skulls

 Describe skull changes due to aging

 Discuss the restorative art significance of the different bones

 Locate bones of the skull

 Locate landmarks on the different bones

efore we get started on the bones, things easier during the birthing process. You B there are a few terms we need to may be familiar with the term “soft spot” introduce, as they very much pertain to bone when referring to a baby’s head. The characteristics we are going to be discussing. technical term for this is fontanelle, and by Crest. Moderately raised border or ridge. 17 months old, they should be ossified (turned into bone). However, it is not until Eminence. A natural raised protrusion. someone is in their early twenties that their Line. Like a crest but not raised as much, not sutures have become fully ossified. Also, as prominent. because the sutures are shaped like the teeth of a saw, sometimes little bits of these aren’t Margin. Border or edge. fully connected during the ossification Process. A projection from one bone to process and the person gets an extra bone, another. Warning: Typically, the process called sutural bones, in their body. While this refers to the bone it is touching, not the bone has no bearing on the RA process and the it is located on. person may never know, it’s still cool to think Okay then, we can begin talking about the some people are walking around with an bones and putting all of it together. extra bone! The sutures of the cranium are: Coronal suture. Separates the frontal and parietal bones. Bones and Sutures of the Sagittal suture. Separates the parietal Cranium bones from one another. Before we get into each individual bone, we Squamosal suture. Separates a single need to discuss sutures. Sutures are non- temporal bone to a single parietal bone on moveable joints that connect the bones of each side. your cranium together. When you are born, these sutures are not yet formed to make Lambdoidal suture. Separates both

23 Creating Natural Form

Figure 8. Bones of the Skull

24 Section I: From Here to There parietal bones from the occipital bone. Occipitomastoid suture. Separates occipital bone and mastoid portion of Glabella temporal bone. Coronal Suture Sphenosquamosal suture. Separates the Superciliary Arch sphenoid bone and the squamosal portion of the temporal bone. Zygomaticotemporal suture. Separates the zygomatic bone and the zygomatic process of the temporal bone. Surface Bones of the Cranium Surface Bones of the Cranium are just that: the ones on the outside of the cranium. There is a total of 6 of them in total: the parietal bones, the temporal bones, the frontal bone and the occipital bone. Figure 9. Frontal Bone Frontal Bone. As the name implies, this is the bone that is in the front of the skull. It the word occiput or back of the head, and this 1 is indeed the back of your head. makes up your forehead and the anterior ⁄3 of your cranium. It has a few features we should • Foramen magnum. Latin for large be aware of: hole, and this describes it well. It is the • Frontal eminences. These exist a few hole in the occipital bone where your centimeters above the supraorbital spinal cord and arteries run through to margin. They vary in person to person, get to your brain. and their significance is that they indicate • Occipital condyle. Latin for knuckles the curvature of the skull posteriorly. on the back of the head, these are located • Glabella. As you may recall, this is the on either side of the Foramen Magnum Latin word for smooth and flat. It is that allows your skull to articulate with located intermediate to the Superciliary the atlas vertebrae. arches, it is the center and most inferior • Superior nuchal line. This phrase portion of the frontal bone. means upper line at the base of the neck. • Superciliary arch. As the name implies It is an attachment point for muscles “arches above the eyes” and that’s This bone articulates with the temporal precisely where they are located. bones and the parietal bones along the • Supraorbital margin. As the name of lambdoidal suture. this one tells us, this is the border or edge The restorative art significance of this above the eyes. bone is that it adds roundness to the back of This bone shares the coronal suture with the head. Luckily for us, is will be hidden in a the parietal bones to the immediate posterior. pillow, so when we restore it, we are more concerned with this area as a leakage point. Occipital Bone. As you may remember the Furthermore, often, a portion of this bone is origin of the word occipital is a conjugation of removed during autopsy. Finally, the

25 Creating Natural Form

6. Muscles Objectives  Identify types of muscle attachments

 Discuss how muscles are named

 Identify muscles that create surface form

 Interpret how muscles are named

 Describe the origin, insertion, and action of muscles

 Recognize muscles by their alternate names

kay, we made it out the other side of Antagonist, contrary action of one muscle. O bones, but we are nowhere near Aponeurosis, a broad flat sheet of done yet. We need to think next about the connective tissue that serves as a muscle muscles of the face. Now, luckily, we are not attachment. going to review all of them, just some of the major ones that a pertinent to RA. This is Synergist, muscles that cooperate with each where our Latin practice will really come in other. handy. Try to use the vocabulary rather than Fascia, fibrous membrane that covers, just memorizing the names. It will help you support, and separates muscle as well as remember them better. unties the skin with underlying tissue. General Muscle Terms • Superficial fascia, subcutaneous covering allowing free movement of the skin. Origin, the more fixed muscle attachment. • Deep fascia, envelops and binds muscles. Insertion, the movable attachment of the distal end of a muscle, is pulled towards the Naming Muscles origin. • Location, where the muscle is located on Action, what a muscle does. the body.

Striation, alignment of muscle fibers. • Shape

Belly, fleshy, central portion of a muscle. • Size of the muscle

Tendon, connective tissue for the • Maximus, largest attachment of muscles to bones and other • Minimus, smallest parts. • Longus, long Sphincter, circular muscle constricting an orifice. • Brevis, short (sounds like brief)

34 Section I: From Here to There

• Direction of fibers

• Rectus, straight

• Transversus, horizontal

• Oblique, slanted

• Location of attachments

• Number of origins

• Action Now keep in mind, like the bones, these words as specified in our restorative art Latin dictionary are used to create a phrase that describes the important information about that muscle.

Muscles of the Cranium Epicranius The epi- prefix comes from the Greek “upon” and cranius means cranium. This muscle is in fact on top of your head and is also known as the occiptofrontalis, a name that is very telling. It consists of three parts from anterior to posterior;

• Frontal belly (frontalis). Covers the forehead and anterior of the skull.

• Origin: Galea Aponeurotica. Figure 18. Muscles of the Face A. Galea Aponeurotica • Insertion: Skin of the eyebrows and the B. Frontal Belly C. Temporalis root of the nose. D. Masseter E. Corrugator F. Orbicularis Oculi G. Procerus H. Orbicularis Oris Galea Aponeurotica I. Levator Labii Superioris Alaeque Nasi J. Levator Labii Superioris K. Zygomaticus Minor L. Zygomaticus Major Frontal M. Buccinator N. Risorious Belly Action of the O. Depressor Anguli Oris Frontal Belly P. Mentalis Q. Depressor Labii Inferioris Figure 19. Occiptofrontalis Muscle 35 Creating Natural Form

• Action: raises temporal cavity, covering parts of the the eyebrows and temporal, frontal, parietal bones. It has no Temporalis Muscle wrinkles the nose. bearing on the form of your face. • Other name: • Origin: Temporal fossa. Muscle of surprise. • Insertion: coronoid process of the mandible by way of a tendon that is deep (goes under) the zygomatic arch. • Galea Aponeurotica. • Action: closes the jaw and is a muscle of From the Latin mastication (chewing). galea meaning “helmet” and Muscles of the Face aponeurosis it a large flat fibrous Masseter connective tissue that connects the Some might say that the masseter might be frontal belly to the the strongest muscle in the body, it is at least occipital belly. the strongest muscle for mastication. No, it can’t lift a car but it can help you chew your • Occipital belly Figure 20a. Temporalis Muscle food. It is a thick muscle that covers the (occipitalis)- ramus of the mandible laterally. It also helps covers the back of the head. shape the buccal regions of your face. • Origin: occipital and temporal bones. • Origin: zygomatic arch and bone. • Insertion: Galea Aponeurotica. • Insertion: angle and ramus of the • Action: by pulling on the Galea mandible. Aponeurotica at stabilizes the position of the Frontal Orbicularis Oculi belly.

Temporalis Corrugator Action of Masseter If when you first read this Orbicularis Oculi word and thought to yourself, “I wonder if this is located near the temporal bone?” Guess what? It is! This is a Masseter radiating muscle that covers the Figure 20b. Masseter Muscle Figure 21. Corrugator and Orbicularis Oculi 36 Section I: From Here to There

8. Our Feature Presentation Objectives

 Describe asymmetry

 Identify the different regions of the face

 Locate the different regions of the face

 Identify general characteristics of the ear, nose, and mouth

 Define the different parts of the ear, nose, and mouth

 Locate the different parts of the ear, nose, and mouth

 Distinguish the structures in different parts of the ear, nose, and mouth

 Discuss restoration and reconstruction of the ear, nose, and mouth

hen you look at an individual, your assumption. This is the area superior to W there some obvious things that pop your eyebrows but includes the glabella area out at you: two eyes, two ears, a mouth, and a between your eyes. nose. As we discussed in the anatomy section, Orbital region. This area surrounds your eye. there are many more subtleties to the face, If you think of a pirate with an eye patch that which the average person doesn’t really think includes coverage of the eyebrow, then you about. However, as restorative artists, we have correctly imagined the orbital region. It must think about as many details of the face extends from the root of the nose lateral to as we can, as we are responsible for seeing the meeting point of your frontal bone and the big picture as much as possible. So, zygomatic bone. From superior to inferior it before we start with the features of the goes from the supraorbital area to the features, let’s take a look at the different zygomatic bone at the bottom of the eye regions of the face. Now most of these will socket. seem rather intuitive to you based on what we have already learned about the different Infraorbital region. The infraorbital region is anatomical features of the face, facial features directly beneath the medial portion of the do not end at the one we have already orbital region. This area extends from the mentioned, but rather, all contribute to the sides of the nose laterally to the zygomatic bigger picture. So, let’s start from superior arch. If one was to draw an imaginary line work our way inferior. down from the corner of the eyes, this would create the lateral border of the infraorbital Frontal region. Based on the name, you are area. This area terminates inferiorly at a likely to have already deduced that this is the plane equal to the base of the nose. area created by your frontal bone and frontalis muscle. You would be correct in Zygomatic region. Just lateral to the

50 Creating Natural Form Infraorbital Region is the Zygomatic region. two parts or aspects of something. For To simply describe it, it begins from the humans, no matter how perfect a face is, it lateral border of the Infraorbital and Orbital must display some sort of asymmetry Regions, laterally to the edge of the ear. otherwise we feel uncomfortable looking at it. Superiorly, it begins on a plane even with the If we observe a person who is too close or lateral corner of the eye and extends perfectly symmetrical, we reach a point in our inferiorly to the same plane as the base of the psyche known as the Uncanny Valley, where nose. we are viewing something that appears to be Nasal region. Snugly placed between the human but is not convincingly human, such infraorbital regions on both sides of the face as a CGI animation or robot. So as a species is, as you probably guessed, the nasal region. we prefer that asymmetry, as it is as nature This area, of course, includes the entire nose. intended. As restorative artists, we also want to observe this asymmetry as it unique to Oral region. The oral region would be the each individual and will make them appear area taken up by orbicularis oris. From more recognizable. Here are some examples superior to inferior, it extends from the base of asymmetry that we may find in each of the nose to the top of the chin. Its lateral feature we will discuss below: borders would be the angulus oris eminences. Mouth. One half might be thicker, or one corner may be more posterior than the other. Buccal region. You may remember the location of the buccinator muscle, and that Eyes. Especially over time, one lid may sag would also describe the buccal region of the more, and the supraorbital areas and face. Its medial border is the lateral border of infraorbital areas may differ the oral region and extends laterally to the Nose. May have different sized nostrils or the edge of the mandible. Its superior border walls of one side may be thicker than the extends from the plane lateral of the base of other. Further, the nose may protrude off the nose inferiorly to the bottom of the body center. of the mandible. Ears. Have the greatest display of a Mental region. No, the mental region is not symmetry, they can vary in size and your brain, it’s your chin! If you draw placement. imaginary lines from the corners of your None of this is to say that this is outside of mouth inferiorly to the bottom of the the norm or the typical expected standard. mandible, you have created the lateral However, any extreme example of this would borders. From superior to inferior, you have be what we call an anomaly, or a deviation the top of your chin to the bottom of your from normal expectancy. Go look in the chin. mirror, see what asymmetries your face might display. Asymmetry Now we have already discussed how the Before you start features relate to each other, but we must As you are working, be sure to change your also talk about how they relate to themselves. perspective. Looking at a facial feature being If we divided the face in half, we can examine reconstructed from the same angle will create what is known as asymmetry, which is the a distorted view. The face and the features lack of equivalence or equanimity between are three dimensions, so be sure to look at

51 Section I: From Here to There you features in both profiles, from superior to feature on a person (okay, that may not inferior, and inferior to superior. Doing so always be true). However, they are still a will spur you to make adjustments from prominent feature of the person, and of different angles as you may say yourself, course very noticeable when viewed in the “Boy, this looks good,” then look from a casket. So, let's look at the parts: different and angle and think “What was I Helix. Simply, this is the outer rim of the thinking?” Furthermore, be sure to step back ear. It originates in the concha with a section from your work to see how it looks at of the helix called the crus (Latin for leg different distances. This too can put things singular). This is a gradual inclination that into perspective. rises out of the concha until it reaches a level Finally, as you work, take breaks. Being plane that curls around the length of the ear too zoned in for too long may cause you to until it terminates on the lobe. An important overthink. Also, feature reconstruction can be feature of the helix is that curls over and frustrating. It helps to take a step back, get creates a shadow. some air, eat lunch, or whatever else you Scaphoid Fossa (Scapha). More Latin to need. Then come back and look again. It will help us remember what this means. The word have given your brain time to process what scaphoid means “boat-like”, and of course you are doing and perhaps inspire you with you remember fossa means ditch. This is the new ideas and a better attitude. shallowest depression of the ear and is Okay, great! Now that we have the general directly medial to the helix, and separates the regions down, let’s talk about the individual helix form the antihelix. features, their features and then of course Antihelix. Directly medial to the scaphoid how to deal with restoration. It is important fossa is an elevation that creates the inner to note that every potential injury is different, rim of the ear called the antihelix, which of and it may require a complete reconstruction course is the mortal enemy of the helix. It or only a fractional repair. In this section, we originates on the lobe and terminates into the will look at the individual parts of every crura, a word that is plural Latin for “leg.” feature, then talk about reconstruction from There is generally a bifurcation into two scratch. At the end of this section, there will crura or “legs” of the antihelix, although it is be checklists that you can use to reconstruct possible that someone may have only one. features, from scratch as if you are in class or The crura are named by location: anterior if you need to use them in the funeral home. and superior. The superior crura is often Speaking of which, it is very difficult to do wider and thicker, although this is the one this if the body is not embalmed beforehand. that is not had by everyone. It is important to Our rule is clean and dry, and if the note here, that the crura recess under the reconstruction is to be done with wax, you helix naturally. could imagine the hydrophobic nature of the wax does not play well with moisture on the Triangular fossa. The triangular fossa is in 1 surface of a tissue. the upper ⁄3 of the ear and is between the crura of the antihelix. It is the second Ears deepest (or second shallowest, depending on whether you are a glass half full/glass half First up, the ears. Now the ears are empty type person) depression of the ear. interesting features on a person, as they have Obviously, it exists only if the person has two the greatest asymmetry between the two. crura of their anti-helix. Fortunately, they are the least recognized

52 Creating Natural Form

Tragus. The tragus is simply a prominence also helps you hear the sounds of the ocean that arises from the cheek and extends over as well as any other noises around you. It is the ear passage from anterior to posterior. Its the deepest depression of your ear and purpose is to help collect sound and direct it funnels noise in to your inner ear so you can 1 into the external auditory meatus. hear it. It occupies the anterior middle ⁄3 of Anti-tragus. Oblique to the tragus is your ear and features the crus of the helix. another prominence just superior to the lobe Lobe. We have reached the inferior one third called the anti-tragus. of the ear, which is of course the lobe. We are all aware of the soft fleshy part of our ear. We Intertragic notch. Not a lot to say about this one other than it is a small depression in should be aware that depending on the between the tragus and antitragus. person, it can be attached or separate from the side of the face. Concha. You may recognize this word as it sounds like “conch shell”, and if you equate Restoration of the ear usually comes in one the two in your brain, that would be a great of the following forms: way to remember it as it is Latin for “shell.” • Complete replacement: we will discuss the Furthermore, what is a common thing one process of reconstructing the ear below. does with a conch shell? They hold it up to • Partial replacement: trauma or pathology their ear to listen for the sounds of the ocean. may cause someone to have part of their This is quite apt as the concha of your ear ear removed. If it is of the wishes of the

53 Section I: From Here to There family, then replace it based on the steps Triangular Fossa illustrated below.

• Removal of fluid: edema or hypostasis can Helix lead the thin tissue of the ear to swell. To remove this, channel in the posterior portions and use manual pressure to release. It shouldn’t take too much effort as the cartilaginous structure of the ear does not absorb moisture like softer tissue does.

• Sagging lobe: As people age, like any tissue, the ear lobe also starts to sag. To bring new life to the ear lobe you have a couple of options:

• During and after the injection phase of Concha your embalming, place cotton behind Scapha the lobe to support it. That way the tissue will fixate in place as the fluid takes effect. Anti-helix • Use tissue builder. You can inject it directly into the lobe to accomplish Trace the outlines for the different for the features as labeled above this.

1. Cut yourself a base. 2. Cut a separate, wedge shaped 3. Cut about a quarter of the wedge piece of clay that is equal in size to -shaped piece from the thicker

your base. side.

4. Trace the shape of a coffin. Note 5. Remove the corners. 6. Smooth the outer edge.

the widest part is in the upper 1⁄3 where the arrow is. Do Not Make A Diamond Shape! 54 Creating Natural Form

7. Using an angled tool, begin 8. The scapha has been excavated. 9. Excavate the triangular fossa. This excavation of the scapha. Notice the shadow cast by the helix. is a delicate step. Be sure not to lose That is the result of undercutting your anterior crura. that edge.

10. Next is the concha. Notice that 11. Once the concha has been re- 12. Your antihelix is probably look- post excavation of the triangular moved, add the crus of the helix. ing a little flat. It should project a fossa, the helix casts a shadow on little bit so add a small piece of clay the superior crura. It has been un- and blend it in. dercut all the way around.

13. Add a bit of clay inferior to the 14. Add another small piece of clay 15. Smooth using water or other helix to create an anti-tragus. to create a tragus. solvent.

55 Section I: From Here to There

Crura

Scapha Crus

Helix Concha

Tragus Anti-helix

Antitragus Lobe

Figure 31. Completed Wax Ear

56 Creating Natural Form Ear Checklist Feature Present Missing Helix Crus of the Helix If missing, add a small bit of clay connected to the helix in

Anti-Helix 2 Crura If missing, add clay to the anti-helix both superiorly and

Triangular Fossa If missing, add depth to the superior end of your anti-helix; this will also help you form two crura Scapha If missing, create a wider gap between the helix and anti-

Tragus If missing, add a small amount of clay anterior to the

Anti-Tragus If missing, add a small amount of clay to the top of the lobe

Intertragic Notch If missing, create space between the tragus and intertragic notch Lobe Proportions Yes No

2 Width is ⁄3 the length 1 Lobe is ⁄3 the length Concha is in deepest depression If it is not, add depth 1 Concha is ⁄3 the length If it is not, widen it from superior to inferior Scapha is the shallowest depression If it is too deep, add clay; you can also add depth to your

Triangular fossa the second deepest depression If it is deeper than your scapha, add clay to the scapha. If it is more shallow than your scapha, add depth to the

57 Section III: What Comes After

21. Case Studies Objectives  Interpret restorative art difficulties in gunshot wounds

 Describe treatment for gunshot victims

 Differentiate between traumatic injury treatment and autopsy protocol

 Describe tumor removal and treatment

 Appraise techniques to allow a family to view a possibly unviewable body

 Describe treatment for damaged skulls

he purpose of the included case Several of these cases are technically T studies is to give you a better demanding. The embalmers here did not understanding of the context of tissue give up, in fact that made them more damage. To fully gauge what the embalmers determined to complete the job. did in these cases, you will have to rely on all Some things that you should think about the information that has been given to you to while you are reviewing the case studies: this point. Some important takeaways from this section are • What other options did the embalmers have while completing the restorations? • The embalmers start with a case analysis that includes the evaluation of the • What unforeseen difficulties could each embalming conditions AND the case have presented? restorative art treatments necessary. As • How does an autopsy effect restoration you have no doubt determined, one does procedure? not work without the other in place. • Besides wax and cosmetics, what other • Injuries do not exist in a vacuum. Often things can embalmer do to conceal tissue one injury is accompanied by others. For damage for public viewing? example, some of the case studies discuss

gunshot wounds. They resulted in fracture and soft tissue repairs and the Case 1 completion of autopsy protocol. In our first case, unfortunately is one that is • Find ways to be creative for more difficult regularly encountered by embalmers; cases. Here you will see the embalmers traumatic wound to the head, with multi- use items for armatures that seem focal areas with well circumscribed injury. As unorthodox but are effective. Anything is often done in these cases, an autopsy was has the potential to help you. performed. • Use these case studies to inspire you.

239 Creating Natural Form

Exit Wound

Entry Wound

Swollen Eye

• An autopsy; as we discussed in our person was given a six-point injection as is autopsy preparation section, when an typical to autopsy. The swelling of the eye individual is autopsied, the main six was dealt with later using an electric arteries will have to be injected, the scalp spatula. A strong arterial solution was preserved, and the features set employed to ensure firm and dry tissues accordingly. In this case, there was no for the later wax restoration. During outward damage to the person’s face, so injection, the wounds were left open, so setting the features could be done without the embalmer could judge the fluid flow interference. However, there is an issue and allow for the drying of the tissue with the eyes. When we’re talking about around the wound. Because autopsy gunshot wounds, percussive effects can cause the eyes to bulge. In this person’s case, the swelling isn’t too extreme, but it Entry Wound is noticeable, nonetheless.

• Entry wound; here we see that the entry wound is on the right side. It displays powder burns around the outside as part of a close range or contact shot. There is also more swelling of the eye on the right side as it to be expected from the percussive outcomes of a bullet.

• Exit wound; The exit wound on the left side is much higher but is generally of equal size to the entry wound. protocol was followed (preserved from • Missing bones; When there is a case with under the scalp) it was not necessary to head trauma, it is not unusual to have suture at any point in the restoration, missing bone fragments that need to be rather filled with wax and cosmetized over. repaired in some way to restore contour. • Entry wound; area was treated with a So now that we have some idea of what we phenol or desiccating compress in order to are dealing with, let's look at how the cauterize and control any leakage from the embalmer overcame them. area. Because this area was in the hair, and the compress was done subcutaneously, • An autopsy; as mentioned earlier the bleaching was not a concern. This would

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