Before & After: How World War I Forged the Modern Face

The Men Without Faces

World War I introduced a new kind of horror to the battlefield. The static, anonymous nature of trench warfare, combined with the devastating power of shrapnel and machine guns, produced casualties on an industrial scale. For thousands of soldiers, the wounds were not fatal, but arguably worse: their faces were shattered, burned, or simply erased. These men, the gueules cassées or ‘broken faces’ of France, were living casualties of a conflict that had stolen their very identities. Society, unprepared and aghast, often hid them away. In some parks, special benches were painted blue to warn the public that any man sitting there might have a distressing appearance.

The first attempt at a solution was more art than medicine. At the Third London General Hospital, Captain Francis Derwent Wood, a sculptor, established the ‘Tin Noses Shop.’ Here, he crafted delicate, custom-painted copper masks for soldiers, allowing them to simulate a normal appearance. These masks were masterpieces of portraiture, but they were a fragile facade. They could not smile, or eat, or feel a kiss. They were a constant reminder of what was lost, highlighting a desperate need for a more permanent, living solution.

An Architecture of Flesh

That solution came from the vision of a New Zealand-born ear, nose, and throat surgeon named Harold Gillies. Horrified by the crude state of facial repair, he convinced the British Army to establish a dedicated hospital for these injuries. The Queen's Hospital at Sidcup opened in 1917, becoming a sanctuary and a laboratory where the foundations of modern plastic surgery were laid, one agonizing procedure at a time. Gillies was not just a surgeon; he was an artist and an architect, famously stating that his work was a ‘strange new art.’

The Walking Skin Graft

The central challenge was moving skin from one part of the body to the face without it dying from a lack of blood supply. Previous methods of skin grafting were prone to infection and failure. Gillies, along with his colleagues, perfected a revolutionary technique: the tubed pedicle. Instead of moving a simple flap of skin, they would cut a strip from the chest or forehead, stitch its edges together to form a tube—protecting the precious blood vessels inside—but leave both ends attached to the body. After a few weeks, once the graft had established a robust blood supply, one end would be detached and surgically ‘walked’ or swung up to the face. It was a slow, bizarre, and often painful process, but it worked. It allowed surgeons to transfer large amounts of tissue with its own blood supply, enabling the reconstruction of entire noses, jaws, and cheeks.

From Battlefield to Boudoir

When the guns fell silent in 1918, the surgeons' new skills did not disappear. The radical techniques developed out of wartime necessity found a new purpose in peacetime society. The 1920s, an era obsessed with modernity, motion pictures, and self-invention, became the first great age of cosmetic surgery. The same principles used to rebuild a soldier's shattered jaw were refined to reshape a film starlet's nose or tighten a socialite's skin. The demand was so great that pioneers like Gillies established lucrative private practices, applying their reconstructive genius to aesthetic desires.

This transition marked the field's fundamental shift from restoring normalcy to pursuing an ideal. It was the birth of a cultural phenomenon, one built on the painstaking work conducted in the operating theaters of Sidcup. Every rhinoplasty and facelift performed today owes its existence to the desperate need to give a man back his face, a legacy of medical innovation forged in the crucible of the world's most devastating war.

Sources

• A Gift of Warfare – The History of Plastic Surgery
• Henry Percy Pickerill – Pioneer Plastic Surgeon
• The History of Plastic Surgery: A Long, Bright Future
• Innovative Cosmetic Surgery Restored WWI Vets' Ravaged ...
• Harold Gillies, pioneer of modern plastic surgery, and ...
• The birth of plastic surgery
• Plastic Surgery Pioneers of the Central Powers in the Great ...
• ASPRS | History of ASPS
• how America surpassed Britain in the development and ...
• The history of facial plastic surgeons