WWI Plastic Surgery
Public Domain
An injured World War I veteran treated by Dr. Harold Gillies, featured in his 1920 book 'Plastic Surgery of the Face.'

The blue benches outside London’s Queen’s Hospital were reserved for men with shattered faces and smashed dreams. The colorful paint job warned the locals that they might want to avert their eyes, shielding them from coming face-to-face with the awful reality of the war and saving the terribly disfigured young men from another look of horror, another uncomfortable stare.

The soldiers who sat on those benches in the years during and after World War I had suffered facial wounds on the Western Front that had never been seen before in warfare. Hailstorms of bullets, exploding metal shells and shrapnel tore off the flesh and ripped off the faces of men who dared to peek out of their trenches or attempt to dodge machine gun fire.

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“The sky was full of shattered iron. Usually, the first thing exposed to this shattered iron were human faces. If soldiers were not killed immediately, those who survived could be horribly disfigured,” says Doran Cart, senior curator at the National World War I Museum and Memorial. “This was a graphic war. There were losses of cheekbones, causing the whole face to sink in. Jaws would be completely decimated. When you put up human flesh and bone against 8-millimeter machine guns, shell fragments and shrapnel, there was no contest.”

Improvements in anesthesia and treating infections also meant that these gruesome battlefield injuries had become survivable. However, facial wounds could be so severe that they left soldiers unable to eat, drink or even speak. As terrible as amputations were, soldiers who lost their faces also lost their identities. “It is a fairly common experience for the maladjusted person to feel like a stranger to his world,” wrote World War I surgeon Fred Houdlett Albee. “It must be unmitigated hell to feel like a stranger to yourself.”

WWI Plastic Surgery
Public Domain
An injured World War I veteran treated by Dr. Harold Gillies, featured in his 1920 book 'Plastic Surgery of the Face.'

Hope, however, resided inside the hospital near those blue benches where Dr. Harold Gillies was pioneering new reconstructive surgery techniques to restore not only the faces of servicemen but some sort of normalcy in their lives. A New Zealand native, Gillies joined the Royal Army Medical Corps at the outbreak of the war. Posted to the Western Front, the ear, nose and throat specialist served in field ambulances and studied with dentists and doctors at the forefront of reconstructive surgery.

“Plastic surgery had been invented centuries before but not applied on any scale,” Cart says. “These reconstructive surgeons figured out new techniques to deal with disfigurements and the anesthetics were better.”

Upon his return to England, Gillies convinced the army’s chief surgeon to establish a facial injury ward inside Cambridge Military Hospital. After a flood of men injured at the Battle of the Somme overwhelmed the facility, Gillies in June 1917 opened the Queen’s Hospital in the southeast London suburb of Sidcup with over 1,000 beds for patients in need of facial reconstructions. Soldiers arrived without chins, noses, cheekbones and eyes. Airmen and sailors came with severe burns. They all endured such psychological trauma that mirrors were kept away from patients.

plastic surgery of World War I
(Credit: Public Domain)
An injured World War One veteran treated by Dr. Harold Gillies, featured in his book 'Plastic Surgery of the Face' circa 1920.

A problem that had long confronted reconstructive surgeons was that patients with skin grafts and open wounds suffered high rates of infection. Gillies combatted this by developing the “tube pedicle” in which he used the patient’s own tissue and skin to ensure continued blood flow to the grafted area to aid in reconstruction.

For one sailor who had the front of his face burned off in an explosion during the Battle of Jutland, Gillies cut strips of living skin and tissue a quarter-inch deep from the patient’s chest, formed a tube that stayed attached at the healthy end, and laid it across the patient’s wounded face. By forming the tube, it solved the problem of infection, and after two weeks, the graft took root in the raw flesh. Surgeons severed the tube and cut apertures for the patient’s nose and throat.

In the case of Lieutenant William Spreckley, Gillies took pieces of cartilage from below the patient’s eighth rib and embedded them into Spreckley’s forehead. Gillies left it there for six months and then swung it down to construct his new nose. Using a cast based on pre-war photographs, surgeons clothed it with skin taken from the lieutenant’s forehead. Spreckley endured multiple surgeries, like most patients, and spent nearly four years in Queen’s Hospital.

WWI Plastic Surgery
SSPL/Getty Images
The facial reconstruction of a soldier whose cheek was extensively wounded during the Battle of the Somme in July 1916.

Gillies assembled a multi-disciplinary team of surgeons, nurses and even artists to assist his patients. Sculptors created likenesses of what the wounded men had looked like before sustaining their injuries, while Henry Tonks, a trained surgeon who became a professional artist, painted portraits of the wounded patients to document their conditions.

One facial surgeon Gillies couldn’t convince to join him in London was American Varaztad Kazanjian. Born in Armenia, Kazanjian came to the United States at the age of sixteen. After attending night school and becoming an American citizen, he graduated from Harvard Dental School. When World War I broke out, he left his successful dental practice at the age of 36 to serve with British forces in France. Called the “miracle man of the Western Front,” he established a maxillofacial clinic that treated more than 3,000 soldiers over the course of four years. Honored by King George V at Buckingham Palace for his service during the war, Kazanjian would become the first professor of plastic surgery at Harvard Medical School.

Although World War I ended in 1918, the work inside Queen’s Hospital continued for years to come. The hospital performed more than 11,000 operations on over 5,000 men until 1925. Considered the “father of modern plastic surgery,” Gillies chronicled his work during World War I in his 1920 book Plastic Surgery of the Face, which included before-and-after photographs of his patients. After receiving a knighthood in 1930, Gillies continued his groundbreaking plastic surgery work on soldiers during World War II and pioneered gender reassignment surgery.

Gillies and his fellow surgeons may not have been able to restore their patients to their original appearances, but they allowed them to have some semblance of a normal life. As Cart says, “They created hope instead of despair.”

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