From Africa’s first titanium 3D printer to 5 000 rebuilt faces

Its name says it all – the Changing Faces, Changing Lives initiative has achieved several global medical and technological milestones and transformed the lives of more than 5 000 patients across the South African public and private health sectors.

The project treats patients suffering from severe facial disfigurements due to cancer, trauma or congenital conditions by merging medical science with advanced mechanical engineering and 3D printing (additive manufacturing).

Driven by the Centre for Rapid Prototyping and Manufacturing (CRPM) at the Central University of Technology (CUT) in Bloemfontein, it has achieved a number of firsts, including being the first and only establishment in Africa to be internationally certified to manufacture medical devices using 3D printing. It has also pioneered several complex medical devices that were the first of their kind on the continent, such as custom maxillary frame implants.

Changing Faces, Changing Lives was also one of 23 case studies selected for Universities South Africa’s (USAf’s) Impact Initiative in 2025, which showcases the positive influence South African universities have on societal challenges.

The Changing Faces, Changing Lives project itself was born in 2016, when the Carl and Emily Fuchs Foundation awarded R2.25 million over four years. That same year the centre received ISO 13485 certification, the international standard for medical devices. Then government asked the obvious question, Dr Booysen said: “How do you take this from 40 patients to thousands of patients?”

He explained that the Department of Science, Technology and Innovation (DSTI) and CUT funded a national Medical Device Additive Manufacturing (MedAdd) technology demonstrator for 3D-printed medical devices, and the centre is now licensed by the South African Health Products Regulatory Authority (SAHPRA) to manufacture them.

More than 5 000 patients have now received CRPM implants or devices.

“Not all of them are pro bono,” Dr Booysen said. About 300 have been treated free of charge through donor funding. “We have to find a balance between the public and private sectors, because to maintain a centre like this, and to get enough money for the ISO certification, you need to find a balance between academic research and industry support projects.”

The work is done by a small team of engineers, Dr Booysen included, and a clinical adviser. The engineers go into theatre, and the surgeons sit beside designers at the computers to plan each case.

However, there is a human element to the numbers.

One patient, a girl, was 10 months old when rats attacked her. She is now 10 years of age and has never been treated.

“So how do I explain to this child that she’s not important?” Dr Booysen asked. She is a public sector patient, and he and his team have tried unsuccessfully to get her a theatre slot at a public hospital. So, as a stopgap, they are making her a facial prosthesis and are looking for help to pay for it.

In state hospitals, Dr Booysen said, surgeons will remove a tumour, but there is often no capacity to rebuild what is lost.

One of his patients had basal cell carcinoma, a form of skin cancer, which had spread through to the eye socket. Surgeons had removed skin and bone.

“If you don’t have a top jaw or a palate, you can’t swallow and you can’t speak,” Dr Booysen said. The CRPM team designed titanium implants that lift the eye socket and anchor an external prosthesis.

Another, a 19-year-old public sector patient, cannot open his mouth. Gangrene that began as a gum infection destroyed part of his upper jaw, and he eats by pressing his food against the roof of his mouth with his tongue. The CRPM arranged his transport to Universitas Hospital in Bloemfontein to be seen by specialists and is now making him a prosthesis.

For a patient with a tumour of the jaw, the team designed a guide that fits over the tumour so that surgeons could cut precisely on both sides, and a patient-specific titanium jaw implant that “just slots in”. That means less time in theatre and a faster recovery.

The benefits go beyond the patient.

“I don’t think people realise that if you have somebody with a tumour, there is always somebody who needs to look after that person,” Dr Booysen said. “So when you can assist such a patient, the mother or father can actually go back to work.”

Dr Booysen recounted how the centre helped an active, sports-focused young athlete named Matthew Booth who lives with a permanent tracheostomy tube. When his parents contacted the centre in mid-2025, he was still using one meant for a young child. He required a tracheostomy tube with a larger diameter to allow for better airflow, but standard options don’t work for him as adult tubes are too long, and paediatric tubes are too narrow.

His father had already built a series of models at home. The CRPM team used the patient’s CT scan data, convert the slice data into a 3D model, in order to get the correct airway, angle and diameter, then designed and printed a titanium tube.

According to his father, the new tube has given Booth a real boost in confidence, and he is able to compete nationally in mountain biking at the same level as his peers. “He’s doing very well,” Dr Booysen said.

Dr Booysen’s strongest message was for universities themselves.

“Universities quite rightly protect intellectual property, research outputs and institutional interests, and I understand those mechanisms are important,” he said. “But there are situations where I believe the societal challenge should come first, and Changing Faces, Changing Lives is one of those situations.

“If one university has the clinical expertise, another has the engineering capability, another has the patient population, and then we get a funder who is willing to support the intervention, I don’t think the first question should be: who owns the IP? I think the first question should be: how do we help the patient?”

CUT’s students are part of the work too. Dr Booysen described a community school where one child has to operate a computer keyboard with a pen in his mouth and a mouse with the side of his face.

“It’s nice to say you can install eye tracking, but sometimes they don’t even have computers, or they have very old computers,” he said. “We assigned this to our honours mechanical engineering students, and we got really nice design concepts, and they are developing them into 3D-printed devices.”

For him, the measure of the work is simple.

“Changing Faces, Changing Lives demonstrates that the ultimate value of universities is not only what we know, what we publish or what we patent. It is what becomes possible in society because that knowledge exists. In this case, research became technology, technology became clinical solutions, and those solutions became changed lives.”

Janine Greenleaf Walker is a contract writer for Universities South Africa.