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Transforming lives: a review of Lindsey Fitzharris’s ‘The Facemaker’ and the pioneering work of Harold Gillies in plastic surgery during World War I

‘The Facemaker’ by Lindsey Fitzharris is a remarkable account of the pioneering plastic surgeon Harold Gillies, who helped transform the specialty of plastic surgery during the First World War. Gillies was a compassionate man, as well as a skilled surgeon, who worked tirelessly to help thousands of men suffering from facial disfigurements caused by the war. While men who lost limbs were treated as heroes, those with facial injuries were often shunned or reviled.

Fitzharris’s book tells the story of Gillies’s achievements and immerses readers in the world of the men he helped, following them from the trenches to the wards where they made long and painful recoveries. Gillies was only 32 when the war broke out, and he quickly realized that a specialist facial surgery center was needed to provide expert treatment for these soldiers. He recruited a multidisciplinary team, including dentists, nurses, an anesthetist, and an artist to document their work. Before long, he was given his own dedicated center in Sidcup, the Queen’s Hospital.

Patients arrived with destroyed jaws, noses, and cheeks, torn-out tongues, and dislodged eyeballs. Gillies had to reopen wounds before starting reconstruction in cases where previous operations left features contorted. With no textbooks to follow, he had to invent his own solutions, often sketching ideas on an envelope and performing multiple operations involving skin, cartilage, and bone grafts. He recreated noses, jaws, lips, and eyelids, using flaps of skin from patients’ chests and elsewhere, leaving them attached by narrow strips to maintain blood supply, then swinging them round to cover facial wounds. One man underwent 40 operations to rebuild his nose.

Despite the book’s harrowing subject matter, Fitzharris presents an intensely moving and hugely enjoyable story about a remarkable medical pioneer and the men he helped. The book includes meticulously clear and detailed accounts of gruesome injuries and grueling operations supplemented by stunning portraits by the war artist Henry Tonks, who depicted patients before and after their reconstructions.

After the war, Gillies set up a private practice where he performed more pioneering operations, including the first female-to-male gender reassignment in 1949. He continued to make significant contributions to the field of plastic surgery, and his work paved the way for future advancements in reconstructive surgery.

Overall, The Facemaker is a fascinating and eye-opening read, providing an important glimpse into the lives of those affected by war and the incredible efforts of medical professionals like Harold Gillies to make a difference in their lives.