BOOK REVIEW - SKILL:  The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I

Author: Dr. Lindsey Fitzharris

Book Reviewer: Sarah Ludington

Despite aspiring to practice surgery one day, I had never truly considered its origins—surgical care seemed too essential to be able to trace its history back to a single moment of inception. While The Facemaker by Lindsey Fitzharris follows Dr. Harold Gillies, historically recognized as the “father of modern plastic surgery,” as he struggles to care for soldiers maimed in World War I, it also chronicles the earliest moments of plastic surgery, honors the ongoing battles after war that Gillies’s patients endured, and demonstrates how reconstructive surgery is fundamentally an act of creativity, collaboration, and deep human empathy.

It seems obvious to me now how modern facial plastic surgery developed in parallel with trench warfare. Soldiers would hide in the trenches and poke their heads up, sometimes just barely revealing their eyes and noses, and be met with bullets and shrapnel and bacteria-ridden mud. Surgical intervention was thus forced into an arms race with Europe’s quickly advancing military technology. As one battlefield nurse wrote, “The science of healing stood baffled before the science of destroying.”

It was through these catastrophes that Queen’s Hospital, one of the first in the world dedicated solely to facial reconstruction, was born. Gillies broke tradition by building and relying on multidisciplinary teams: he called on surgeons, physicians, dentists, radiologists, artists, sculptors, mask-makers, and photographers to take on an increasing number of soldiers with increasingly complex cases. Surgeons had historically been lone operators, siloed into their own fields due to limited resources—and oftentimes ego. Fitzharris illustrates how anatomy and art became a shared language across disciplines, crucial to the development, documentation, and replication of advanced techniques like tubed pedicle skin flaps and jaw reconstructions, especially in the absence of metal plating, rods, and the antibiotics to support such operations. It becomes clear how elite surgery relies just as much on teamwork and humility as it does on absolute technical mastery.

Although Gillies sought to solve unprecedented surgical challenges, it is evident his physical success was driven by the compassion he showed his patients. Unlike soldiers who returned from war with amputated or prosthetic limbs, those with facial injuries were not welcomed home warmly. Facial differences had long been viewed as signs of moral or intellectual inferiority, often associated with syphilis, corporal punishment, and sin. Gillies, however, was stubborn—and endlessly kind. Infantrymen marveled at receiving the same degree of care as their officers, often recounting how he would visit them at night to check in on them. Today, this idea underscores the principles of modern medical ethics, particularly those of justice and autonomy. Gillies once confessed that “hardest of all was the task of trying to rekindle the desire to live in men condemned to life week after week smothered in dressings and bandages, unable to talk, unable to taste, unable even to sleep without opiates because of the agony of lacerated nerves, and all the while knowing themselves to be appallingly disfigured.” Although it is easy to view the surgeon through the stereotype of sterility and technicality, Gillies’s approach serves as a profound reminder that surgery is built on immense empathy. Reconstructive surgery inherently cannot strive to only restore the body’s form and function, but one’s identity and wellbeing as well.

However, not everyone viewed this surgical progress favorably, and this controversy is echoed in discourse around plastic surgery today. At the time, people quite literally believed that God’s punishments manifested as illness and one’s physical imperfections were indicative of the soul. Thus, the idea that reconstructive surgery would allow someone morally or medically corrupt to pass as healthy and unmarred was immoral, even dangerous to society. Further, Gillies work progressed to the point of paradox: “the same standards of beauty that deemed Gillies’s work necessary also led to some patients being seen as ‘failures’—even by themselves—when surgery could not alter their appearance in ways that met those standards.” In contrast to some other surgeons at the time, Gillies was very comfortable with creating entirely new looks for his patients. He even offered patients an album of different nose types to choose from and boasted that some patients were even more pleased with their new features than before their injuries. Today, fueled by the boom of social media, aesthetic plastic surgery faces similar scrutiny regarding homogenized beauty standards and public misconceptions. Just as in Gillies’s time, however, it highlights the complex role elective procedures play in addressing cosmetic, functional, and psychological needs. While discussions are ongoing, one central takeaway persists from Gillies’s time to now: every patient’s experience with reconstructive surgery is deeply personal and requires continuous conversation, nuance, and grace.

The Facemaker is not quite a biography of Harold Gillies, nor is it a history lesson on World War I or the modernization of facial plastic surgery. It is, rather, a testament to how the surgeon can heal both the body and mind. At a time when severe facial injury meant complete social isolation for veterans, Gillies sought to provide an opportunity to return to normalcy and a sense of self for physically and psychologically wounded patients. This book is heavy, it is uplifting, and it is a reminder of what we can accomplish when social and clinical courage is paired with imagination and tenacity.

Author: Dr. Lindsey Fitzharris

Dr. Lindsey Fitzharris is a New York Times bestselling author, television host, and medical historian with a PhD from the University of Oxford. A regular contributor to The Wall Street Journal, Scientific American, The Guardian, The Lancet, and New Scientist, she is known for bringing the grisly, surprising, and deeply human history of medicine to life. Her debut book, The Butchering Art (2017), a celebrated account of Victorian surgery, won multiple literary awards, earned international acclaim, and has been translated into 20 languages. In 2021, she hosted the Smithsonian Channel series The Curious Life and Death of…, exploring some of history’s most mysterious deaths. Her follow-up book, The Facemaker (2022), about pioneering First World War surgeon Harold Gillies, was an instant New York Times bestseller and debuted at #4 on the Los Angeles Times bestseller list.

Book Reviewer: Sarah Ludington

Sarah Ludington (she/her/hers) is a rising third-year medical student at Duke University School of Medicine. She graduated with honors from Stanford University with a B.S. in Neurobiology and a minor in Psychology. As an undergraduate, she developed novel protocols for studying the neural basis of motor-based communication in poison frog tadpoles. During her third year of medical school, Sarah will continue conducting basic science research and study peripheral nerve regeneration in orthopedic and plastic surgery. She is also passionate about patient advocacy and has contributed to research projects across gender affirming surgery, food insecurity, and cost-saving initiatives for patients without insurance. At Duke, she is an Armstrong Scholar in the Trent Center for Bioethics, Humanities, and History of Medicine and serves on leadership for DukeMed Pride, Medical Students for Choice, and Duke REMEDY, a volunteer organization that collects and distributes medical surplus globally. Outside of medicine, Sarah enjoys upcycling thrifted finds, dancing and practicing yoga, and playing with her dogs, Brandy and Fisher.