[Describing World War I] Only one village in all of France escaped without losing at least one of its citizens. This explains why, even in the tiniest of villages, there is a monument honouring those who were killed in the war. Every year, wreaths are laid, and ceremonies are held. Wherever we went, people kept returning to one theme: the extraordinary amount of blood that had been shed. “World War II,” they would say. “Oh, it was terrible, but it was nothing compared to the Great War.”
Don Kladstrup, Petie Kladstrup – Champagne: How the World’s Most Glamorous Wine Triumphed Over War and Hard Times
World War brought unimaginable devastation to millions of lives. Historian Lindsey Fitzharris frightfully writes in her book The Facemaker that World War I required “endless supplies of human fuel” as “humankind’s military technology had wildly surpassed its medical capabilities.” Soldiers huddled in trenches, grappling with despair, as machine guns rattled, relentless artillery bombardments shook the earth, and gas attacks brought chaos and misery. The mental and physical toll was beyond comprehension, as soldiers were nothing more than carcasses to be patched up and thrown back into trenches.
The injuries suffered by soldiers were far different from those seen in previous wars. Facial wounds from exposure to poisonous gas, burns, shrapnel, and infections were devastating. Simple actions like placing an injured soldier on his back on a stretcher could lead to suffocation from blood flow. The men who survived the battles were often left disfigured beyond recognition, condemned to suffering and alienation, as the public welcomed heroes but not mutilated soldiers.
The lasting stigma associated with disfigurements remains evident even today. Iconic characters such as Captain Hook from “Peter Pan,” the Wicked Witch of the West from “The Wizard of Oz,” or Gollum from “The Lord of the Rings” embody this painful circumstance.
You only have to look to Hollywood and how they use disfigurement to signify evil. It’s a lazy trope. You have Joker; you have Darth Vader, you have Voldemort, you have Blofeld. The list goes on and on. Harvey Dent in “Batman Begins” doesn’t become evil until he’s disfigured. Then he becomes Two-Face.
Lindsey Fitzharris in an Ars Technica interview
There is a crack in everything; that’s how the light gets in.
Leonard Cohen
Harold Gillies, a New Zealand surgeon trained in England, was 32 years old when war broke out. He enlisted in the Royal Army Medical Corps. Initially stationed in Wimereux, near Boulogne, he took on the role of a medical minder to Charles Valadier, a French-American dentist attempting to develop jaw repair work. Intrigued by Valadier’s experiments with early skin graft techniques, Gillies visited Paris to meet the renowned oral surgeon Hippolyte Morestin.
Upon returning to England, Gillies persuaded the army’s chief surgeon to establish a facial injury ward at the Cambridge Military Hospital in Aldershot. However, this facility quickly proved insufficient, leading to the development of a new hospital dedicated to facial repairs in Sidcup. The Queen’s Hospital, which opened in June 1917, along with its convalescent units, provided over 1,000 beds. There, Gillies and his colleagues honed various plastic surgery techniques as they performed over 11,000 operations on over 5,000 men.
Verdun memorial, France | © OliverKepka / Pixabay
Given the brutal nature of the photographs depicting WWI facial disfigurements, they have not been included in this article. Readers are encouraged to take a moment to brace for the severity of these facial wounds and to appreciate the unimaginable skills that Gillies and his team demonstrated in addressing them. This link has detailed images of soldiers’ horrific wounds in World War I. May those who were affected by these injuries rest in peace.
Alone we can do so little. Together we can do so much.
Helen Keller
Amidst the despair, grief laid heavy. But so was determination. Gillies was among the first surgeons to consider the importance of aesthetics in facial reconstruction, recognizing that patients’ emotional well-being was closely tied to their appearance. He established a multidisciplinary team of surgeons, dentists, physicians, artists, painters, sculptors, photographers, mask makers or cosmeticians to rebuild and repair faces and identities.
In this collaborative effort, renowned beauty entrepreneur Elizabeth Arden also played a role.
Another of [Elizabeth Arden’s] wartime initiatives was to set up her laboratory in London to work on creating a special covering cream for her friend Sir Harold Gillies and his team of plastic surgeons. Known at his hospital as scar cream, it was based on hydrogenated coconut oil, isopropyl myristate, lanolin, zinc oxide and titanium dioxide. The Arden chemist added yellow ochre, burnt umber and Persian orange to the mix, and it worked wonders on battle-scarred victims, covering shocking burns.
Lindy Woodhead – War Paint: Madame Helena Rubinstein and Miss Elizabeth Arden: Their Lives, Their Times, Their Rivalry
Gillies and his team operated countless hours, sketching faces on the backs of envelopes, inspiring soldiers (“Don’t worry, sonny, you’ll be alright and have as good a face as most of us before we’re finished with you”), creating the foundations for modern plastic surgery.
One of Gillies’ most significant contributions was the development of the “tubed pedicle” technique (warning, detailed photos here or in its leading article here), which involved using a flap of skin from a healthy part of the patient’s body, such as the chest or forehead, and attaching it to the damaged area while maintaining a blood supply.
Before antibiotics, the skin could not simply be removed from another body part, such as the leg, and placed on the face. Instead, the skin was cut but left attached and then stitched into a tube shape to maintain blood flow and reduce the risk of infection. This allowed blood to circulate continuously and promoted the growth of healthy skin. Once the tube had grown long enough, the free end was attached to the desired site.
Gillies achieved remarkable results using this technique, and he later learned after the war that two other surgeons had developed this technique simultaneously. Although the tubed pedicle method is no longer widely used today due to advances in reconstructive surgery, it was highly innovative at the time.
Gillies understood that complex facial reconstruction often necessitated multiple surgeries, and he championed the principle of staged procedures. He famously said, “Never do today what can honourably be put off till tomorrow”, underscoring the importance of patience and planning in achieving the best possible results.
We are all apprentices in a craft where no one ever becomes a master.
Ernest Hemingway
After the war, Harold Gillies transitioned into private practice, focusing on cosmetic surgery, a post-war emerging and lucrative industry.
He said reconstructive surgery was about returning something to normal, whereas cosmetic surgery was about surpassing the normal. He was an innovative surgeon, and he was excited about those new challenges. He understood the psychological impact of even a slight flaw that other people might not notice; it could still have a huge impact on someone’s personality or mood. So he felt that he was truly helping all of these patients.
Lindsey Fitzharris in an Ars Technica interview
Gillies’ pioneering spirit extended to performing the first successful phalloplasty on a trans man named Michael Dillon. Gillies had experience working on genital reconstruction for injured soldiers during World War II, which equipped him for this surgery. Amid the intense media uproar that ultimately forced Dillon to leave the nation, Gillies remained supportive, upholding the principle that individuals should be free to choose their own appearance. Subsequently, Gillies and his team conducted male-to-female sex reassignment surgeries on Roberta Cowell.
Gillies was knighted as a reward for his war services. Sir Harold Gillies’ groundbreaking work in reconstructive surgery during and after World War I paved the way for modern plastic and reconstructive surgery. His compassionate approach, innovative techniques, and commitment to his patients revolutionized how we approach facial reconstruction and cosmetic surgery, forever changing the face of society.
Resources:
Lindsey Fitzharris’s interviews and excellent book The Facemaker