The Garden Route’s reputation as a world-class medical tourism destination is gaining momentum as a growing number of professionals establish themselves and their state-of-the-art equipment here. The country’s first 3D printers for prosthetics, a surprising concentration of top-notch dental milling equipment and the latest in non-surgical skin procedures are among them.

WORDS Corrie Erasmus and Athane Scholtz PHOTOGRAPHS Ruan Redelinghuys and supplied

Custom fit prosthetics

George-based medical orthotist/prosthetist/podiatrist Werner Marx is the first in South Africa to use 3D print technology to produce prosthetics.

Mostly used for building models in architecture and engineering, 3D printing creates a three-dimensional object from successive layers of material formed under computer control.

“I work in a manufacturing industry where a lot of time is spent customising prosthetics before they are finally ready to be used by patients. Technology fascinates me and I have been searching for more accurate and user-friendly ways of creating prosthetics,” Werner says.

While searching the internet, Werner was inspired by Canadian artist Natasha Hope Simpson, who became one of the first people in the world to have obtained a 3D-printed prosthesis. With her design background, she helped design the prosthetic. “I knew then that it was possible to use 3D printing to create prosthetics,” he says.

Werner came across American company 3D Systems, which seemed to have the kind of printers for his objectives and flew to their South African distributors, CAD House in Johannesburg, to find a machine that could print a socket – the part into which the stump of an amputated limb fits and which is essential to a patient’s comfort. He bought his first machine in June last year.

There were no guidelines for printing prosthetics, which meant Werner had to experiment, through trial and error, with various temperature settings, different prosthetic filament (materials), and printer settings to create proper fitting, high-quality braces and prosthetics. Six months later, he had the confidence to ask a patient, Johan Stemmett, to test the socket for his prosthetic leg. “Initially I thought we would have to try a few times to get it right, but the very first prosthetic socket I’d printed for him on the 3D printer fitted perfectly. His feedback was that it was very comfortable. In all my years, this has never happened.”

The process involves scanning the body part where the brace or prosthesis is necessary and importing the image into a computer programme. Sculpting software designs the prosthesis or brace and, when Werner is satisfied the measurements are correct, design data is placed on a memory card and inserted into the 3D printer. The printer, loaded with the suitable filament, prints the prosthetic socket or brace, a process that can take up to 30 hours. After manually cleaning up excessive material, reinforcing the socket with carbon fibre, polishing and attaching the metal fittings, the result is a prosthesis that fits perfectly and comfortably. Werner has since bought two more printers to cover the workload, which now includes various braces to support arms, wrists and fingers.

In addition to accuracy and time saving benefits, 3D print technology means measurements can be saved and the prosthetics reproduced exactly when needed. There is also no cost difference between a 3D printed prosthesis or brace and a traditionally manufactured one.

There is a huge variety of filaments on the market, which is continuously being improved. While he currently uses ABS filament – the material used for Lego blocks – Werner is also experimenting with a carbon filament that has great strength and weight benefits.

Other applications have also transpired. Werner printed a 3D foot skeleton for local specialists to help them plan their surgeries. “It may significantly reduce time on the operating table if they can prepare in advance with the 3D printed version.”

Werner has also printed a replica of the archaeological finding, the Naledi skull, as a school teaching aid.

He wants to focus on creating personalised prosthetics, which was unheard of before. “Many young patients prefer to show their prosthetic limbs these days and funky designs will offer them something unique,” he says.

Milling away

A relatively high concentration of world-class dental milling equipment in the Garden Route is believed to be an indicator of the region’s increasing reputation as a safe, affordable and respected international medical and dental tourism destination.

Knysna-based Dekodent South Africa is the importer and distributor of the latest in high technology milling machines as well as high translucent zirconium, a relatively new dental material in the industry. A company representative says the fact that at least two of their German manufactured imes-icore 250i milling machines are on the Garden Route is significant, especially considering there are not many elsewhere in the country.

Dekodent believes this prevalence is linked to the country’s international reputation for providing quality dental work with state-of-the-art equipment – combined with a favourable monetary exchange rate and beautiful Garden Route surroundings.

Dental milling machines have revolutionised production of a wide range of dental prostheses, including temporary and permanent crowns, and implants. The computerised equipment allows dental technicians and dentists to digitally design the prosthesis. Cylindrically shaped material is inserted into the machine and robotic arms manipulate a series of drill bits to cut the dental prosthesis.

For dental technicians, the major advantage of milling machines is the significant time saved to create a prosthesis, which in the past had to be painstakingly created by hand. While expensive, the benefits and value the machine adds makes it worth the while. “It puts us on par with top dental technologists in the world. If you walk into a dental technician’s lab in New York, you will find exactly the same technology,” says a George-based technician.*

Skin deep

Registered nurse and Skinstitute owner Christine de Villiers was the first in the Southern Cape and one of the first seven in the country to introduce the Italian-made Plexr non-surgical plasma tool. Christine describes it as a wonder soft surgery tool, which can be used for an array of skin applications including sun damage repair and tattoo removal, but it is its non-invasive proven success with Blepharoplasty (baggy eyelid correction) that attracts the most attention. “No botox, no fillers, no scalpels, no cutting and no lazers.

“By far the most impressive is the short recovery time following a Plexr treatment. In today’s busy lifestyle people want dramatic results without surgery and without long periods of downtime”. Traditional eye lid surgery can take weeks to heal while most people require two to five days’ down-time after Plexr.” Christine’s business partner, Dr Jean du Plessis, performs the eyelid soft surgery treatment and she does all other procedures.

She says South Africa is a respected and well-known international destination for aesthetic procedures. “Europeans in particular have come to realise they can have the same or better treatment in South Africa at a fraction of the overseas cost. While many of them are ‘swallows’ who have second properties on the Garden Route and use their summer time to catch up on treatments and surgery, there are also many local and overseas visitors to the region who plan holidays around aesthetic procedures – giving them time to recover, going back home looking well rested,” says Christine.

Dr Herman van Rooyen and Dr Adri Hofmeister of Skinlogic also have state-of-the-art laser machines and echo sentiments that South Africans not only keep up with the latest technology, but are among the best medical service providers in the world. As regular speakers at international congresses and trainers in specialised equipment and dermal fillers, Herman says the clinic works closely with dermatologists, plastic surgeons and specialists to provide a comprehensive service so patients get the correct treatment under medical supervision for their specific conditions. “Modern computerised equipment is updated online, which ensures we stay on par with everyone else.

“While our international clients benefit most, the Garden Route is up to 30% more affordable than elsewhere in the country, a fact that is slowly becoming known and attracting patients. We also find there is no more on or off season – in winter patients want procedures such as laser, which require them to remain out of the sun, while summer attracts less invasive work that heals quickly and can be shown off.”