In this article, optical 3D acquisition, reverse engineering and rapid prototyping are proposed for virtual sculpturing and fabrication of facial prostheses. A novel approach to the direct mould production by means of rapid prototyping fabrication is introduced. Full coverage of the surface is obtained by using multi-view acquisition and alignment of point clouds. Suitable topological description is provided by triangle tessellation. Depending on the clinical case, one or two prototypes can be used either to directly cast the final prosthesis or to fabricate the positive wax pattern. The method has been applied to the development of a nose prosthesis; its generality is investigated in the case of virtual ear modelling. The advantages with respect to known art manufacturing methods are addressed.