Book of the week

The Facemaker

by Lindsey Fitzharris

Allen Lane 336pp £20

The Week Bookshop £15.99

For many soldiers in the First World War, “the fear of being permanently disabled was more terrifying than death”, said Wendy Moore in The Guardian. And worst of all was the prospect of facial disfigurement. While those who lost a limb were “treated as heroes”, those with damaged faces were “often shunned or reviled”. The New Zealand-born surgeon Harold Gillies devoted his working life to these men, transforming the emerging art of plastic surgery and helping thousands to “literally face the world again”. At the Queen’s Hospital in Sidcup, Kent – the world’s first specialist maxillofacial unit – he developed pioneering reconstructive techniques, including complex “skin, cartilage and bone grafts”. Lindsey Fitzharris’s “engrossing” biography isn’t for the fainthearted: it is full of “gruesome injuries and gruelling operations”. Yet it provides a “moving and hugely enjoyable” portrait of a brilliant and “extraordinarily compassionate” man.

Today, when cosmetic surgery is primarily associated with “elective procedures for the wealthy and vain”, this “fascinating” book is a useful reminder that it “evolved under the most brutal conditions”, said Lorraine Berry in the LA Times. The “mechanised weapons” of WWI “destroyed flesh more efficiently than ever before”: some 280,000 soldiers on the Western Front are thought to have been facially disfigured. Their injuries triggered “primal emotions and beliefs”. Each country had its own term for such people: in France, they were les gueules cassées (“the broken faces”), in Germany, das Gesichts entstellten (“the twisted faces”), while in Britain they were the “Loneliest of Tommies”.

The procedures Gillies developed to treat such men – a decade before the discovery of penicillin – are astonishing to read about, said Jennifer Szalai in The New York Times. To “fashion a nose”, he would take a patient’s rib bone and attach it to his shoulder, thus building “new cartilage”: this “nose” would then be grafted onto the face. To treat severe burns, he’d cut a flap of skin from the chest, leaving it “attached on one side for the sake of the blood vessels”, and then stretch it across the lower face, attach it, and sever it at the other end. Many of these techniques were later used by Gillies’s cousin, Archibald McIndoe, to treat pilots burned during the Battle of Britain, said James Riding in The Times. McIndoe is now more widely remembered, somewhat unfairly. This book, full of “blood, bacteria and disembodied limbs”, is certain to help “correct this imbalance”.