Review: A history of plastic surgery in ‘The Facemaker’

On the bookshelf

The Facemaker: A Visionary Surgeon’s Battle to Repair Disfigured WWI Soldiers

By Lindsey Fitzharris
FSG: 336 pages, $30

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“The man had almost no face; a bullet had hit his mouth and exploded, going through his cheeks, breaking his jaws, ripping out his tongue, one end of which was hanging out, and blood was gushing profusely from those horrible wounds,” a witness wrote after the battle. The man had lived, but he wondered “would even his own mother have recognized him in such a state?”

Plastic surgery, today more commonly associated with elective procedures for the rich and vain, actually evolved under the most brutal conditions and with the noblest aims. In “The Facemaker,” Lindsey Fitzharris offers a fascinating medical history of the development of the discipline. Its catalyst was World War I, when modern mechanized weapons destroyed flesh more effectively than ever and doctors struggled to keep up.

“Unlike amputees, men with disfigured facial features were not necessarily celebrated as heroes,” Fitzharris writes. “While a missing leg can elicit sympathy and respect, a damaged face often evokes feelings of revulsion and disgust.” The 280,000 men who returned with such wounds would have suffered a fate worse than death on the battlefield. Designated as “the broken mouths” (broken faces) in France, they triggered primitive emotions and beliefs about the connection between the face and the soul.

Mechanized warfare is the mind-body problem at large. As the methods of science and engineering advanced to create killing machines, they forced people to distance themselves with the disfigurement that followed. But they also challenged doctors to repair the body in ways that would soothe the mind. Physicians who entered this new terrain had to combine the science of medicine with the art of reconstruction, sculpture and healing.

(Farrar, Straus and Giroux)

Among these pioneers was Harold Gillies, a British doctor who invented techniques to treat horrific facial injuries. Born in 1882, Gillies lived a comfortable life as a London surgeon focusing on ear, nose and throat problems. After the start of the war, he volunteered and was sent to France in January 1915. There he met Auguste Charles Valadier, a Franco-American who had returned to France to practice dentistry.

On the front lines, Valadier saw that his dental skills were needed to treat more than rotten molars. Gillies watched the dentist use bone grafts to repair injured jawbones and realized that they were crucial in rebuilding recognizable faces. Valadier, writes Fitzharris, “took a section of a patient’s rib and inserted it under the flesh of his forehead in order to reconstruct the soldier’s nose. Once the graft was taken, Valadier reshaped the skin around it.

As Fitzharris navigates her way through various types of trauma — missing noses, amputated jaws, burns that charred her entire face — she recounts the rise of various medical arts brought to bear to treat them. She brings cultural commentary and social history of ableist notions of beauty and health into these discussions.

In the development of rhinoplasty, for example, citing scholars such as Zander Gilman, Fitzharris shows how a person’s nose has become a marker of their health. As late syphilis attacked the nose, people so afflicted were considered to bear evidence of moral turpitude. The large-scale mutilation of soldiers reminded civilians of the depravity of modern warfare. World War I had garnered huge support across Europe; those who had paid the price for civilian jingoism were treated as monstrous in part, according to Fitzharris, as a manifestation of collective guilt.

Sir Harold Gillies and Dr Cochrane Shanks

Sir Harold Gillies (in white coat), the pioneer plastic surgeon during World War I, accepting a donation of X-ray machines from the Allied Relief Fund of America in 1940.

(Associated Press)

But the face is more than a symbol; it is the basis of human communication. The visual cues that sighted people get from the position of an eyebrow or the perceived sincerity of a smile carry more weight than we recognize. Men wounded in the face were not only objects of repulsion; they were cut off from normative forms of social interaction. All over Europe, the wounded preferred that these men withdraw from society.

In addition to pioneering surgical techniques during the conflict, Gillies campaigned for specialist hospitals where men with facial injuries could be treated. These hospitals have become more than just research centers; they served as social spaces where patients felt freed from the need to protect those repelled by their injuries. They were centers for rehabilitation, providing recreation and access to art, music and theater as well as access to new skills such as woodworking that would serve men in the afterlife. -war.

Fitzharris successfully balances the growth story of plastic surgery with a compassionate care for those whose injuries made it possible. Photos that document the “before and after” faces of patients are carefully chosen, including the decision not to post photos of those who later die of their injuries. Fitzharris follows the lives of patients after they are discharged from the hospital. Many of these stories had happy endings, with Gillies patients leading fulfilling family lives and careers.

The stories of the First World War are deeply personal to me. My great-grandfather, Robert Raymond, died in October 1917 from injuries sustained at Passchendaele, in a battle that killed or injured 600,000 soldiers in three months. My grandmother was 10 months old when her father died, a common story in the UK, which has lost almost 800,000 men and injured 1.6 million – an entire generation of young men who have been victims of the decisions disasters of older men.

Robert died at an evacuation station while being cared for by the kinds of caregivers Fitzharris pays tribute to. At a time when changing your look to follow the latest Instagram trend is ridiculously easy for those who can afford it, it’s shocking to remember the terrible human price paid for the advancement of cosmetic surgery. But these compensation stations are the legacy that I honor the most. They still operate on the front lines of a society in which we still call on doctors to undo the horrific damage done to body and mind by readily available weapons of war.

Berry writes for a number of publications and tweets @BerryFLW.

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