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Who Was the Father of Modern Plastic Surgery?

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Modern-day plastic surgery is an expansive field, with surgeries falling into two categories: cosmetic and reconstructive procedures. While cosmetic plastic surgery focuses on the aesthetics of a patient, reconstructive surgery is designed to restore function to a damaged part of the body.

To understand how plastic surgery has developed and evolved over time, we must track back through history to the chaos of World War One. Although facial reconstruction was not a new surgery at the time – rudimentary nose jobs were reported to have been performed in Ancient India – the demand for facial surgery had never been so great.

The advancements in battlefield technology that killed around 8.5 million people also left 280,000 men from France, Britain and Germany with facial disfigurement. Rather than being treated as heroes, these soldiers were ostracized on their return from war.

Harold Gillies, a British surgeon, was at the epicenter of the flourishing field of plastic surgery during the war, working to repair the faces of veterans.

In a far cry from the sterile operating rooms, anesthesia and antibiotics used in modern-day plastic surgery, Gillies’s working environment made the surgeries he performed risky.

The anesthesia used consisted of either a rag of chloroform over the patient’s mouth or a very basic mask that delivered ether. The problems with this approach were two-fold. The mask or rag would disrupt the surgical field and the surgeon could end up inhaling the fumes himself. In addition, Gillies was operating in a time before penicillin existed, meaning that if a patient contracted sepsis from the surgery, there was little to be done, increasing the risk of death.

The surgeries themselves were complicated – they were tailored to each patient, with some patients needing multiple operations over a span of years. The intricacies of each surgery led Gillies to develop some of the pioneering techniques used in modern plastic surgery. For example, he could craft a nose from a patient’s rib and take cartilage from the shoulder to form the nose bridge, before grafting it to the patient’s face.

Another common technique used for facial reconstruction was making a deep cut near a wound on the face to mobilize the tissue, enabling a surgeon to maneuver the skin to cover the damaged areas, while maintaining blood supply to the tissue graft.

Gillies’s work during the First World War prepared him to perform further surgeries throughout World War II, where he continued to pioneer novel surgical techniques, this time in genital reconstructive surgery for injured pilots. This in turn led him to accomplish the first phalloplasty – the formation of a penis through surgery – in the late 1940s.

The plastic surgery techniques that Gillies pioneered helped “plastic surgery flourish and enter a new era,” according to Dr. Lindsey Fitzharris, author of Harold Gillies’s biography: The Facemaker: One Surgeon’s Battle To Mend the Disfigured Soldiers of World War I.