The History of Rhinoplasty ⑧ — Harold Gillies: reconstructive surgery forged by war

What established modern plastic surgery as a speciality in its own right was the First World War.

Trench warfare was unlike the wars before it. The body was down in the trench and only the face was above it, taking bullets and shell fragments.

There is a record of 2,000 facial injuries occurring in ten days at the Battle of the Somme.

Harold Gillies (1882–1960), a New Zealand-born British army surgeon, argued the case for a ward given over to facial injuries and opened a hospital at Sidcup, outside London, in June 1917.

It was the first hospital built solely for reconstructive surgery, with more than a thousand beds. Between 1917 and 1925 some 5,000 people underwent over 11,000 operations there.

The technique Gillies is best known for is the tubed pedicle.

Skin from the chest or forehead was raised with one end left attached and rolled into a tube, keeping the blood supply, lowering the risk of infection, and moving it to where it was needed.

The principle will look familiar. It is the same idea as Sushruta’s flap from part two. With 2,500 years between them, the same principle appeared again in a different form.

What stays with me from the records is not the surgery.

At the hospital, patients were kept from seeing mirrors. Some of the benches outside were painted blue — a sign that the face of the person sitting there might come as a shock.

What Gillies set out to give back was not only the shape of a face. It was a state in which a person could stand in front of others again. That was the goal.

These days I mostly do rhinoplasty for aesthetic reasons.

And yet following this line down, I always arrive at the same place. The root of the craft of working on noses was never beauty but recovery.

It is why I find myself asking what this person wants to get back, before asking what surgery could add.