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Face masks

A transparent face mask, sometimes called a TFO or “transparent facial orthosis”, is a see-through mask that is worn when a person’s face burn is making scar tissue or is at risk to scar. By applying pressure to the burn or scar, the face mask keeps the skin soft and flat during the scar forming phase of healing. It helps the face heal with the least amount of scarring. The transparent face mask is worn 18-20 hours every day for 8 months to 2 years until the skin graft is mature.

The use of a transparent face mask was invented in 1975 by Elizabeth Rivers, an Occupational Therapist working at the Regions Hospital Burn Center. It has advantages over a fabric face mask in that it is less visible when a patient is wearing it than the fabric hood. Also, therapists are able to see how well the mask is compressing the scars and make modifications to it as needed.

New Face Graft - Cool the Burn

This is a new face graft right after the graft was done.

 
Regions Hospital - Burn Center - Mature Face Graft

This is a person with a face graft that is mature, about two years after the injury. The skin graft is done healing. The skin is mature when it is soft, flat and light in color.

 
Regions Hospital - Burn Center - Fabric Face Mask

Some burn centers recommend using a fabric face mask. The fabric masks are made from the same tight elastic fabric as compression garments.

 

How to make a transparent face mask or TFO

To make a transparent face mask, a model or impression needs to be made of the patient’s face. It does not hurt to take an impression, but some young children are put to sleep during the process because it might frighten them.

Regions Hospital - Burn Center - Coating face with petroleum jelly

The first step in making the mask is to put a thin coat of petroleum jelly over the patient’s face and ears. Next, the face is covered with a gooey, oatmeal-like substance called Jeltrate. To let the patient breathe, however, Jeltrate is never put over the nostrils or the mouth.

When the Jeltrate sets up in a few minutes, it becomes very rubbery.

The Jeltrate impression of the face is then reinforced with strips of plaster which harden in about ten minutes.

Regions Hospital - Burn Center - Cover face with Jeltrate

After the plaster has dried, the mask is removed from the patient’s face. The inside of the mask duplicates the curves of the person’s face and is called a “face impression”.

Next, the face impression is filled with liquid plaster. When the plaster dries, it forms a solid head.

Regions Hospital - Burn Center - Face impression filled with liquid plaster

After the plaster has thoroughly dried, the layered plaster strips are cut and carefully removed from the impression. Then the rubbery Jeltrate is peeled away as well.

Regions Hospital - Burn Center - Dried plaster Jeltrate pulled away

Next, the therapist cleans the plaster head and sands it smooth.

Meanwhile, a sheet of transparent plastic is heated in an oven until the plastic is soft and pliable.

Regions Hospital - Burn Center - Transparent plastic sheet heated

This warm plastic sheet is then draped and completely pressed over the plaster head.

Regions Hospital - Burn Center - Warm plastic sheet pressed over plaster head

After the plastic cools, the therapist cuts openings in the mask for eyes, nose, mouth and ears, and attaches elastic straps to the sides.

Regions Hospital - Burn Center - Plastic is cut for eyes, mouth, nose, ears

The therapist alters or revises the mask daily with spot heating to increase pressure on the patient’s scars. As the skin tissue matures, fewer revisions to the mask are needed.

Regions Hospital - Burn Center - Daily alterations to mask Usually, most patients wear their masks for 8 months to 2 years to achieve the best results possible.

Transparent neck orthosis (TNO)

A transparent neck orthosis is a see-through neck splint that is worn after a neck burn. The splint helps the neck graft or burn heal with the least amount of scarring and helps keep neck range of motion. It is worn 18-23 hours a day for 8 months to 2 years until the scars are mature.