Aesthetic Concerns Prosthetics Inc. of Newburgh is one of three major companies in the world that specializes in constructing lifelike prostheses. The process of making a finger, hand, nose, ear or foot that looks just like the real thing is exacting work that utilizes skilled artists, who fashion a series of molds made out of wax, metal and silicon, finish the silicon “living skin” by applying hairs and vinyl nails, and then paint it.
In an echo of the medieval guilds, a team of 12 painters, sculptors, metal casters and wood carvers performs the meticulous work at tables laid out with art materials, aided by creaky machines that slosh the glovelike parts in chemical baths and then vigorously rotate them to ensure even distribution of the silicon inside the metal molds.
It”™s definitely a niche business, with each piece customized for the recipient. Yet this odd hybrid of clinic and art studio, located in 4,500 square feet of a brick former textile mill, isn”™t that different from the more mundane chip manufacturer or soda maker struggling to grow and prosper in a climate of stiff competition. Finding ways to operate more efficiently is a constant challenge. Ensuring a stable work force and providing incentives to keep talented, ambitious employees is another factor.
Artists sign up for a three-month apprenticeship that”™s a testing period for the painstaking work. Director of operations, Phillip Castore, a sculptor who formerly ran an art restoration business, said one in 10 don”™t make the cut. Those who do start at $12 an hour, but there are opportunities to expand one”™s skills within the company and eventually become one of the traveling teams of clinicians who meet with patients.
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”˜Utilitarian manufacturer”™
Aesthetic Concerns ”“ its product is called Livingskin ”“ doesn”™t just offer prostheses that look good. Through its association with parent company Prosthetics & Orthotic Associates Inc. (P&O) in Middletown, it can offer patients every type of prosthesis and orthotics they need ”“ one that resembles a real hand or arm for social situations, a mechanical one for doing tasks and perhaps a third piece for performing athletics.
Providing a full spectrum of prosthetic services is what makes the company distinct from its competitors and attracts customers from as far away as Hong Kong and Buenos Aires, said its founder, president and clinical director, Thomas Passero. “Understanding the profile of customer service and patient care is our primary role, and recognizing this has grown our business dramatically,” he said. “None of the other silicon manufacturers is also a utilitarian manufacturer.”
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Passero is well qualified to understand the need: He himself is an amputee, having returned from the Vietnam War intact only to lose the lower part of his left leg after getting hit by a drunk driver. The frustrations he experienced in finding prosthesis that would enable him to resume his athletic activities motivated him to attend Northwestern University Medical School and become an American Board-certified prosthetist.
His practice led to the founding of a community-based customized-prosthetics facility in Middletown in 1989, which was profitable from day one. He invested $300,000 of his own money to launch Aesthetic Concerns in 1996. Today, total revenues for both companies, which employ 40 people, is just under $10 million. Aesthetic Concerns has earned an average of 25 percent net profit on total sales in the last five years, an impressive margin achieved partially through the shift toward providing more direct access to patients, said Passero, who ran the New York City marathon in 1991.
Sixty-five percent of the Aesthetic Concerns”™ business consists of prostheses sold at retail prices direct to the client, with the remainder manufactured at wholesale prices to other companies in the U.S. and Canada. (At P&O, 100 percent of the products are sold to the end-user directly.) Clients can visit the Hudson Valley offices or meet with staff in clinics in Boston, Atlanta, Chicago, Toronto and New York City.
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Strategies for growth
As the companies grew, Passero hired a CFO to help him develop effective strategies to guard against competitive threats. The purchase of another local prosthetics company in 2003 gave his firm a dominant presence in the Hudson Valley. Aesthetic Concerns also acquired a metal-mold fabricating firm, enabling it to perform a critical process in-house rather than outsourcing it, as it had in the past, thereby saving hundreds of thousands of dollars.
To make the companies viable in the long term, Passero has developed stock option plans for key employees allowing them to acquire ownership in the company. “We”™re trying to capitalize on the inherent desire for people to succeed and get benefits beyond the weekly paycheck,” he said. The company also supports the artistic careers of its employees, with an art gallery at the Newburgh facility dedicated to showing their work.
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P&O is planning to build a new facility in Middletown over the next two years that would bring the Newburgh portion of manufacturing back to the home office and expand from the current 8,500 square feet to between 10,000 and 15,000 square feet. The building will be green (the company”™s most recent green initiative was purchasing a hybrid car) and employees will have the opportunity to invest in a share of it. “They”™ll own the building where they work,” Passero said. “When they”™re my age” ”“ he”™s 57 ”“ “they”™ll have some ownership and some wealth in this physical asset.”
The company also leverages technology wherever it can. “We have invested in a technology company that dominates the prosthetic and orthotic fields, so we can utilize all digital services at a discount,” said Passero. He”™s also investigating the use of sophisticated computer imaging and is working with a Baltimore-based firm that is seeking to expand its architectural scanning business into prosthetics.
While imaging is routinely applied to leg prostheses, hands, fingers and facial components are very complex, so the crafting of these parts is still reliant on artists. They take a negative impression of the sound hand or ear, reverse the form to replace the missing part and fill it with wax, and then sculpt the missing ear or hand by hand.
Replacing portions of this process with the new imaging technology would shorten the time period from one or two weeks to one or two days. Artists would still be needed for the finishing work and also to create the wax molds, since the computer can”™t replicate the fingerprint detail of these forms, Passero said.
Another exciting development is integrating mechanical devices with Livingskin to create a prosthesis that not only looks real but also functions. A Scottish company called Touch Bionics, which has developed a sophisticated electronic and mechanical hand with advanced grasping capabilities, is meeting with Passero this May to discuss the possibilities of clothing its hand with a Livingskin. Meanwhile, Aesthetic Concerns is experimenting with tougher, more durable materials, such as urethanes, Kevlar and composites, which would hold up much better than silicon to rugged use.
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Results are gratifying
For Castore, one special aspect of the job is the daily interaction with clients. After the prosthesis is finally finished, there”™s the momentous step of fitting it to the recipient ”“ an emotional rollercoaster for both the client and the prosthesis maker.
While a few people are resistant, usually the results are gratifying. Many individuals feel more comfortable in social situations and are also able to do more thanks to their new prosthesis.
Some customers are children. A 6-year-old boy from Turkey who was born with a deformed hand resisted his parents”™ attempts to have him fitted for a prosthetic. They were concerned that without it, he would be stigmatized for life. That was six years ago, and Castore said the boy, whose hand is refitted as he grows, now “acknowledges its importance. He”™s fine, and his parents have calmed down.”
Castore said the company has a warehouse full of expensive metal molds ”“ the cost for a finger prosthesis is $3,000, with a hand selling for $10,000 ”“ that perhaps could help fulfill the enormous need for prostheses in developing countries. “It”™s taking Jim”™s finger to put on Paul,” Castore said, noting that the cost would be much reduced since the molds have already been made.
Before taking action the company needs to investigate a number of complex issues, including distribution and the role of governments. But he had no doubt the effort would be worthwhile: “Some people are so thankful,” he noted. “The work doesn”™t have to be at the highest level.”
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