I am pleased whenever I am asked intelligent questions about what I do, and I thought the cost of trauma restoration deserved its own post.

First of all, restorative art is a term that can include several small procedures as well as large, labor-intensive work like accident victims or suicides. Many parts of the embalming process that I would consider routine are actually restorative in nature, as opposed to preservative. If a person has died from cancer or another wasting disease, or just became very thin in old age, I will inject a filler material into the gaunt areas of the face to fill out the temples or lips to make them look healthier. Not youthful; I cannot make an 80-year-old woman look 40, but I can make her look like a healthy 80-year-old. When people remark their mother looked better dead than she ever did alive, it’s a given that this injection has been done. This is considered a restorative procedure, but is not an itemized cost because it takes so little time. It can be done while the embalming fluid is being pumped in via machine.

A small gunshot wound can also be easily concealed. After the body is embalmed and allowed to “set up” overnight, I can stuff the wound full of cotton saturated with carbolic acid (phenol) to cauterize any areas inside the head not reached by the embalming fluid. Remember, the fluid is injected arterially and overnight will diffuse to the other tissues of the body, but will not reach an open wound. Typically I need to cauterize the wound after embalming, then remove the cotton the next day and possibly repeat the procedure. Mortuary cosmetics are wax-based and are meant to work on dry, firm tissue.

After the wound is sufficiently dried, I will re-add a layer of cotton webbing and then cover it with a clear glue to give me a flat, smooth surface on which to work. I’ll warm up some wax to body temperature and use it to cover the cotton and glue. Sometimes the wax is enough and other times I will have to paint over the wax with an opaque cosmetic in the person’s skin tone. Then I use brushes or metal tools to create pores or lines so it looks like natural skin. Depending on the location of the wound, I may need to replace hair, which can be taken from the back of the head or drawn on with cosmetic.

This can also be done on an unembalmed body if the wound is cauterized, though the cosmetic will not adhere as well.

The instances when I have to charge extra are when I receive a body that will take several days of work, such as a shotgun to the face, or if the body has had many bones and tissues donated. Bone donors are one of the worst cases we can get.

A bone donor will arrive to me as basically a floppy sack of skin with an attached ribcage, head, hands, and feet. Only the head can be embalmed. The skin of the arms and legs must be spread out and wrapped around PVC piping or broom handles, then sewn together. I leave an opening into which I can stuff powdered formaldehyde. This will adequately preserve the body but in no means will restore a natural appearance. It is essential the family bring in long sleeves and pants, and a high collar. Since the piping cannot bend like human joints, the body will often be positioned with the arms at the sides rather than folded. No matter what, the body will look like a human head on top of weird stick limbs.

An autopsy repair or a major tissue donor involve the same amount of work, and cost usually double the embalming charge, which in most funeral homes is anywhere from $300 to $700. The thoracic and abdominal cavity, as well as the head, must be opened and treated while the limbs are embalmed separately. A normal embalming job can often be completed in an hour or two. An autopsy may take four hours, or all day.

If I get an accident victim or facial gunshot that I know will take days of work, often I will give the family an estimate of the cost per day, something in the area of $150 for each day. Those kinds of jobs are impossible to know how long they will take until you get started. My last complete shotgun facial restoration took three days, and involved piecing together the facial bones; replacing the remaining skin over those bones; and creating the appearance of skin where there was none. He then needed heavy makeup due to the multicolored bruising. Many women are familiar with color-correcting cosmetics; layering yellow base makeup to counteract the purple color of under-eye circles or green makeup to disguise a ruddy complexion. A face that has exploded and then been exposed to harsh chemicals and minor decomposition will be many shades of purple, orange and red.

I always say as long as there is still something of a face present and no advanced decomposition, I can restore the appearance. It’s a source of personal pride and accomplishment; after all, it’s what I went to school for. Regretfully, many families assume viewing will not be possible and have resigned themselves to a closed casket before coming to the funeral home. If you have lost a loved one in a disfiguring manner, please do not rule out the possibility of a viewing. If your funeral director is not experienced in restoring certain cases, she can call a specialist, or you can choose another funeral home. If cost is an issue, always ask about discounts or other options. Personally I love the opportunity to practice the most challenging cases and would gladly be flexible on the financial aspect if it were a slow week and I had the time to devote to just the one body.

There are some bodies that can never be restored, including advanced decomposition (think dead for a week before being found); severe burns; complete removal of the face; or the body being flattened. But if the situation is just a gunshot or car accident, never take no viewing for an answer without seeking a second (or third or fourth) opinion. One judgment call I had to make was allowing an 11-year-old girl to view her brother who collided with a semi truck on a motorcycle. Every bone in his body was broken; I couldn’t even dress him. The medical examiner and two funeral directors told me “absolutely not viewable.” The girl and her mother viewed him, unembalmed, just washed off and draped in a hospital gown.

They left laughing and hugging me. Later they decided they wanted his face restored and I had it done (not my work) and while they were appreciative of the effort, they had already seen him several days in a row with no work being done and had become used to him the way he was. They told me they actually preferred visiting him in his natural state.

And that is another issue: we are never allowed to deny a family the right to view. It doesn’t matter if the person was dead for a month and half eaten by his dog – they want to see him, they can see him. I will recommend against it and will have them sign a liability waiver, but I can’t refuse to allow it. I have had families view unrepaired autopsies; shotguns that turned faces to hamburger; and a 400-lb woman dead for over a month before being found. I do not understand their decision but they did not regret it. I chose not to view my brother as there was very little left of him; he had been underwater for over a year and eaten by fish and turtles. I had a very good last day with him and that is what I wanted to remember, but when it’s not my family, it’s not my decision. Closure means very different things to different people.