Moulage meets medicine: Making simulations feel real with special effects makeup

medical moulage - Maeve Geary at work
Photo: Katherine C. Cohen/Boston Children’s Hospital

Maeve Geary, BDes, to our knowledge, is the first PhD candidate to specialize in medical special effects simulation. A native of Belfast, Ireland, she completed a Bachelor of Design degree in Special Effects Development at the University of Bolton (Manchester, England). She has been with Boston Children’s Hospital’s Simulator Program, SIMPeds, since April 2016. At SIMPeds, she has contributed to a variety of custom “trainers” and is exploring whether increasing the realistic look and feel of mannequins impacts training and trainees’ ability to learn. Recently, she led the development of a trainer for urinary catheterization in infants — complete with visually and haptically accurate genitals, urethral opening and fat rolls.

It’s now apparent that treating medical mannequins with greater visual and haptic realism makes medical simulation training more effective for clinicians. Moulage, or special effects makeup, is an important part of making simulations feel real.

Here’s a quick tutorial in some very basic effects achieved with simple, readily available drugstore ingredients. Although much of my research is on complex fabrication techniques adapted from the film and television industry, these techniques are simple and accessible to all. (If you’re in Boston, attend our live demos this week!)

Simulating bruises

bruise color palette for medical moulageAlways plan and research your make-up, as fashion make-up designers do. For example, when creating bruising it helps to understand how color can convey the age and severity of bruises.

When red blood cells break down, they release the iron-containing protein hemoglobin, giving blood its bright red color. So when you first get a bruise, it appears red. As bruises begin to heal, our bodies convert the hemoglobin into other colored chemicals. As a result, the bruise will progress from red to blue to purple within the first couple of days after an injury.

simulating bruising in medical moulage

As the bruise starts to go away, it turns green, due to the presence of a hemoglobin breakdown product called biliverdin. In the final stages, green bruises turn yellow — from hemoglobin’s final breakdown product, bilirubin.In reality, most bruises are multicolored. This is because the amount of blood in different areas of the bruise varies, and the stages of healing overlap.

Color can be applied to a mannequin’s surface with a brush or sponge. You can stipple, flick or dab the color and create multiple layers.

Simulating burns

medical moulage - simulating burnsBurns require more materials. Check a medical reference for the appearance of first, second, third or fourth degree burns. You can add to the realism with simple and readily available materials, such as: polyvinyl acetate (PVA) glue, which is similar to Elmer’s glue and dries clear; charcoal powder (for use in simulated third and fourth degree burns) and KY jelly or Vaseline.

Experimentation can lead to more detailed effects. You can pluck at the materials to achieve texture or apply a peel-off facial mask and inject pigmented KY jelly to simulate blisters.

For more detailed, dimensional wounds, you can make gelatin “flesh” and apply it directly to the mannequin’s skin. Recipe: 1 part powdered gelatin, 1 part hot water, ¼ part glycerin (to adjust density/softness) and ¼ part sorbitol (to increase tensile strength and helps prevent tears). Add your pigment (most store-bought makeup foundation will work) and any other ingredients a little at a time. Once created, gelatin flesh can be stored in the fridge or freezer and microwaved in 10-second increments back to its molten state when needed. Take care not to overheat the mixture, real burns could occur!

Simulating wounds
medical moulage - simulating wounds with flat transfers

With more complex but achievable techniques, “flat transfer” wounds can be sculpted, molded and cast in the same gelatin flesh as above, then transferred to the mannequin (or actor’s) skin. You can blend prosthetic edges by dissolving them with witch hazel and (if needed) a thickened or creamed prosthetic adhesive to fill gaps.

Simulating blood 

medical moulage - transfer wound - Maeve GearyUse glycerine, syrup, food coloring and instant coffee granules to create fake blood. Colors will vary depending on whether the blood is arterial (red) or venous (blue). Don’t be afraid to experiment with your ingredients to prioritize particular properties.

You do not need Hollywood-grade, expensive materials to achieve high-fidelity moulage. You simply need research, planning and a little practice. If you are involved in clinical simulation, there are few excuses not to improve realism in make-up effects.

If you’re in Boston, you can see moulage in action at the SIMPeds Open House on Friday, September 15 (11 a.m.-1 p.m.) as part of the first ever Global Healthcare Simulation Week. Location: 3 Blackfan Circle, 18 Floor, Boston (across from Boston Children’s Hospital). #HcSimWeek

RSVP now