The facial aesthetics industry is known today as one that caters to celebrities, feeds a desire to be beautiful. An industry assumed to be couched in vanity, perhaps. But it found its beginnings somewhere quite different. With Remembrance Day just around the corner, it felt appropriate to honour some of the first facial architects, and pay homage to the incredible, life-changing work they performed.
Prior to the First World War most wartime injuries were the result of small arms fire or blade wounds. Facial injuries were possible, but often of little concern to survivors who most would consider lucky to have escaped with their lives. World War One gave rise to new sorts of military arms – heavy artillery, machine guns, poison gas. Such destructive weaponry caused injury at a scale and severity not seen before. The nature of trench warfare itself, with men peeking over parapets, meant that facial injuries among soldiers were far more common, and often far more severe, than they had previously been. As many as 280,000 combatants were left with facial disfigurements, which often led to them being shunned in civilian life.
They were called the “loneliest Tommies”, and when they were discharged from hospital they were made to sit on benches painted bright blue, so members of the public knew not to look at them. Historically, facial procedures were an area in which very little had been attempted or explored. Surgeons would sometimes stitch together a jagged wound without taking into account how much flesh had been lost. When the wound healed the flesh tightened, pulling the face into a grimace.
Harold Gillies, a New Zealand born surgeon working in England, endeavoured to do better. In 1915, he established a special ward for facial wounds at the Cambridge Military Hospital in Aldershot, and by 1916 he had established an entire hospital dedicated to the cause, The Queen’s Hospital at Frognal House. The aim was to reconstruct wounded men’s faces as fully as was possible. It was pioneering work at the time. In the same way that our doctor’s today consider the impact of their work on range of expression in the face, and pay mind to aesthetic ideals, any surgeon of the time aiming to reconstruct a face would have to consider loss of function in the face, as well as the aesthetics of what would make the reconstructed face socially acceptable, and spare the men the blue bench. There were no textbooks or instructional materials available to guide them. Gillies described his ventures into facial reconstruction a “strange new art”.
Gillies was joined by William Kelsey-Fry, who was qualified in both Medicine and Dentistry, and together they developed a multidisciplinary team, which could jointly treat both bony and soft tissue elements to progress the development of this new specialty. One of the main techniques developed was tube pedicle skin-grafting, wherein a flap of skin was separated but not detached from a healthy part of the soldier’s body, stitched into a tube, and then sutured to the injured area. A period of time was needed to allow a new blood supply to form at the site of implantation. It was then detached, the tube opened and the flat skin stitched over the area that needed cover.
And Gillies wasn’t the only pioneer. Over in France, Suzanne Noel, a dermatologist, was called to serve in military hospitals. She had had a budding interest in cosmetic surgery prior to the onset of the war, but now she had the opportunity to gain invaluable knowledge and experience in the discipline by working on soldiers whose faces had been partially amputated and who were in need of severe reconstructive surgery. She was interning under some of the best reconstructive surgeons going, specifically her mentor Morestin, who taught her to take calculated risks on the operating table. She sought further guidance from Thierry de Martel, an accomplished neurosurgeon with an extensive knowledge of the facial nerves, for help in solving face-lifting issues without causing further facial nerve damage.
As a result of her dedicated work, she won the silver medal of National Recognition for distinguished conduct in 1918. Following the war, she established her own private clinic, performing cosmetic procedures.
It’s a far cry from aesthetic procedures today, but undoubtedly paved the way for the progression of cosmetic medicine. Indeed, Gillies is often referred to as the “father of plastic surgery”, and many of his techniques are still used in modern surgeries. From his work emerged the modern notion of cosmetic practice – for the first time, patients could choose the nose or jaw their doctor would build for them.
Surgical or not, we are able to do what we do today because of the difficult work of others, at an incredibly difficult time. It may seem a frivolity now, but the dawn of facial aesthetics is anything but frivolous.
Lest We Forget.