The Facemaker

Lindsey Fitzharris’ book describes the amazing innovations in plastic surgery brought about because of the horrors of World War I.

War is hell, but often it leads to advances in medical technique that translate to peacetime. In The Facemaker, Lindsey Fitzharris tells the inspiring story of Harold Gillies, a visionary surgeon who battled to mend the disfigured soldiers of World War I whose horrific facial injuries had left them unable to eat and so mutilated that they were unrecognizable. He learned as he went along.

One of the early lessons was that these patients should not be placed on their backs because they would drown in their own blood; it was better to place them face-down and allow the blood to drain. He eventually created a specialty clinic in England with a multidisciplinary team that included surgeons, dentists, nurses, anesthetists, artists, photographers, psychologists, and more, even musicians. He had some spectacular successes in rebuilding faces that were once deemed unsalvageable.

He also had failures. A section of before-and-after photographs illustrates some of his successful cases, one of whom became his private secretary. He developed multistage procedures, rebuilding the underlying structures, tubed pedicle grafts and other innovations, and even experimented with masks and prostheses. Some techniques were not new, but he is considered the father of modern plastic surgery. Today it is a board-certified specialty, which it was not prior to WWI.

After his retirement from the military, Gillies continued to practice plastic surgery, expanding his private practice to include cosmetic surgery and so-called “vanity” operations.

The book is meticulously documented. “Anything placed between quotation marks comes from a historical document…any descriptive references to gestures, facial expressions, emotion, and the like are based on firsthand accounts.”

A Franco-American dentist named Auguste Charles Valadier converted his luxury Rolls-Royce into a mobile operating room on the front, retrofitting it with a dental chair, drills, and equipment – all at his own expense! He later became part of Gillies’ team.

She also tells about the chef who escaped German captivity by preparing a huge banquet laced with liqueurs and wines, got his captors drunk, and calmly walked away to freedom. It sounds like the script for a sitcom, but truth is stranger than fiction.

There are descriptions of patients with horrific facial injuries who were left bleeding on the battlefield for days on end because stretcher bearers believed they were doomed and not worth picking up. It was a scene from Hell. Bacteria-laden mud was everywhere, contributing to contamination and infection. Hasty first aid measures often made things worse and had to be reversed by the plastic surgeons.

Conclusion: A very worthwhile book

The medical vignettes are interspersed with historical information. We could all benefit from knowing more about gas attacks, shell shock, and the details of this tragic episode in our history.

I can highly recommend this book to anyone who wants to learn more about plastic surgery and/or the history of WWI.

This article was originally published in the Science-Based Medicine Blog.

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine Blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.

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