Facial wounds are the particular hell of the Great War. Due to trench warfare characteristics, facial wounds in WWI were more numerous and more terrible than in any conflict before or after. It created severe physical and psychological problems, but plastic surgery advanced dramatically in this period and gave relief to these veterans. 

The Great War created disfigurement and mutilation in staggering numbers. No part of the body was safe in the new industrial warfare. The great advancement in medical care meant that soldiers survived wounds that would have killed them in the past but also left their body mutilated and disfigured in higher numbers. These soldiers not only had to cope with their functional rehabilitation but also the emotional trauma. 

Among disfigurement and the trauma that went with it, face wounds occupy a special place. 
This kind of wound was considered more grievous than any other mutilation because it may incapacitate the functionality of the men’s body, but also his soul, his very perception of himself. 

‘Very severe facial disfigurement’ was among the injury granting a veteran full pension. From 1917, this pension was calculated not just on the loss of functionality or earning capability but also in relation to normative concepts of masculinity. Disfigurement compromised a men’s sense of self and social existence. 

Masks (The Great War #AtoZChallenge 2021) Facial wounds are the particular hell of the Great War. Due to trench warfare characteristics, facial wounds in WWI were more numerous and more terrible than in any conflict before or after.… Click To Tweet

Plastic surgery

Often, the treatment of soldiers with facial wounds was problematic, in the sense that reconstruction of the face was left until last, as doctors dealt with more life-threatening wounds. By the time patients got under the care of specialist units, their faces had started to heal, which made reconstruction even more difficult. It required plastic surgeons to devise new and innovative ways to treat these patients. 

Plastic surgery of the face had been an established practice even before the war, but it was only with WWI that it became its own speciality and more aesthetically concerned. Men who were gravely disfigured in their faces often found it extremely difficult to be accepted back in society and even by their own family. Plastic surgery then made an effort to restore the functionality of the face as well as its socially acceptable look. It was teamwork that involved surgeons but also dentists, nurses, photographers and artists. 

But surgery was not enough. Harold Gillies was one of the first doctors to realised that the traditional way to treat facial injuries was not working and devised a new method, where surgery went hand in hand with psychological support. His hospital files were full of photographs that documented the improvement patients went through, and these photos were often given to the patients to see that improvement. The general atmosphere in the hospital was uplifting, which seemed to affect the patients’ recovery positively. 

Facial masks

But sometimes, plastic surgery couldn’t restore the looks of a man. Men who lost a limb had prosthetics and clothes to hide it, but how could one hide his disfigured face? And some were truly horrid. But these men had an opportunity that was close to a prosthetic: face masks.

Silver facial prosthetics originally developed in France as early as 1833. During and after WWI, this branch of prosthetics knew its high point. It involved doctors and artists since these masks were highly personalised and were each a one of a kind piece. 

It was time-consuming labour, but it gave good results. 
First, the patient’s face was cast in plaster-of-Paris, which was then chalked and a clay or plasticine squeeze taken. This gave a positive model of the healed face, and it was on this that the artist worked to recreate the features of the person. Once the missing features had been sculptured, the artist took a final cast, electroplated to produce a copper mask 1/32 of an inch thick. This was then coated in silver and painted, matching the exact colour of the men’s skin and any other missing feature, like eyes and eyebrows. 

These were often partial masks that covered only the damaged part of the face and were kept in place by ribbons or attached to spectacles. 

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RESOURCES

International Encyclopedia fo the First World War – Mutilation and Disficuration
NCBI – The Rhetoric of Disfigurement in First World War Britain
Hektoen International – A Journal of Medical Humanities – The psychological impact of facial injury in the First World War: outcomes from the Queen’s Hospital, Sidcup
The Atlantic – Masks: The Face Transplants of World War I
National Army Museum – The Birth of Plastic Surgery
Science Museum Group Journal – Projecting soldiers’ repair: the ‘Great War’ lantern and the Royal Society of Medicine

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