When we think of plastic surgery nowadays, we often think of cosmetic procedures where people want to look younger or more attractive. But plastic surgery has its roots in reconstructive surgery, often to deal with injuries inflicted while at war. The plastic surgeries performed today have their roots in one of the deadliest conflicts of all time: World War I.
A French gas attack on German trenches in Flanders, Belgium, 1917.
For most of human history, surgery was a costly gamble. Even if you were to survive a surgery with no anesthesia, you would still be living in a world with no antibiotics where your surgical site could get infected (leading to death). So surgery was a last chance endeavor even if you could find a doctor willing and able to do it. It would have been almost unheard of to go “under the knife” by choice rather than the most dire emergency. There were a few physicians during the Golden Age of Islam who attempted and published about cosmetic procedures including the famed al-Zahrawi, an Arab surgeon, but they were incredibly rare. But the nineteenth century brought both the horrors of modern warfare as well as medical advancements that made surgery much safer.
Football team of British soldiers with gas masks in France, 1916.
World War I is often called the first modern war and resulted in a loss of life that had never before been seen. There were an estimated 30 million military casualties–not counting the millions of civilians who died. The injuries sustained by those fighting were different from those seen before. Instead of a sword or small arm wound, soldiers encountered shrapnel from heavy machinery, burns from newly-developed chemical weapons, and machine guns. In addition, the introduction of hard metal helmets made head injuries more survivable but meant that injured soldiers might have gruesome, disfiguring injuries including to their faces. By the end of the war, hundreds of thousands of broken men returned home with the evidence of war written clearly on their faces. There was even a term coined for these men: gueules cassées, French for “broken faces.”
Unidentified Canadian soldier with burns caused by mustard gas, c.1917.
The early attempts at fixing these wounds often involved surgeons stitching together the broken edges of skin while not accounting for the skin that had been lost. This treatment resulted in a tight, pulled look almost like a grimace. Several doctors saw these poor results as well as the stigma that faced the wounded as they left service and aimed to create new techniques.
Gueules cassées at Versailles, France, 1919.
French surgeon Hippolyte Morestin was working at a hospital in Paris during World War I and experimenting with facial skin grafts when he was observed by New Zealand surgeon, Harold Gillies. Gillies went on to pioneer facial reconstruction during the war. His patient Walter Yeo, an English sailor who lost both his upper and lower lids while on a warship, is now considered to be the first person to receive advanced plastic surgery. Gillies went on to perform 11,000 operations on over 5,000 men, continually improving his techniques and training other doctors during this time.
Walter Yeo before and after his surgery, 1917.
While hundreds of thousands of men suffered long-term disabilities as a result of the war, many survived and were able to return home and lead relatively-normal lives. The advancements made by these pioneering surgeons laid the foundation for modern plastic and cosmetic surgeries that continue to help soldiers, accident victims, and people born with craniofacial differences today!