Tin Noses: The Faces of War

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Were noses really made out of tin after WWI for disfigured soldiers?

Cosmetic. Plastic. It’s unfortunate that these are the terms chosen to describe the general field of surgery that rhinoplasty falls under. The connotation is of something “less than” or “fake”. Cosmetic jewelry is not real jewelry. Plastic is often a cheaper version of something made of a more valuable material. Cosmetic or plastic surgery can give rise to thoughts of vanity and the pursuit of something not quite genuine.

Unfortunate may well be too mild a descriptor, because, whether people want to admit it or not, how we look matters. It matters a great deal. If there is any doubt about this, we need look no further than to the thousands of brave service members who have suffered devastating and life-altering wounds that left them horribly disfigured. So many of these individuals survived the war but were never able to return to their lives because of the shame of their appearance, unbelievable as that should be.

Writing about World War I in the “Faces of War” for the Smithsonian Magazine, journalist Caroline Alexander wrote, “Within the surgical and convalescent wards, it was grimly accepted that facial disfigurement was the most traumatic of the multitude of horrific damages the war inflicted.”

That is an amazing statement. WWI claimed 8 million lives and wounded an additional 22 million. No one was prepared for the damage that level of military technology could inflict on the human body. Inexperience and a certain innocence made soldiers especially vulnerable to facial wounds. According to an American surgeon working in France, “The soldiers failed to understand the menace of the machine gun. They seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of bullets.” Plus, the addition of the twisted metal shards of shrapnel into the mix, which unlike the straight line wounds made by bullets, had the unique ability rip all or a portion of a face off, changed everything.

Reconstructive facial surgery at the beginning of the war was in its infancy. Field hospitals and surgeons were overwhelmed with patients who survived but were missing large portions of their faces. Sir Harold Gillies, a pioneer in the art of facial reconstruction, who, barely in his 30’s, was thrust into the middle of all of this by the British Army, remembers his war service, “Unlike the student of today, who is weaned on small scar excisions and graduates to harelips, we were suddenly asked to produce half a face.” A single day in 1916, the beginning of the Battle of the Somme, brought Gillies and the other doctors in his unit more than 2,000 patients.

It is said that miracles were performed by these doctors as they raced to help as many of these injured soldiers as they could, often creating new techniques as the need for them was presented. But, a hundred years ago, there was only so much that they could do. Some injuries were just too severe, many of these involving a totally missing or mangled-beyond-repair nose.  For those soldiers, the Masks for Facial Disfigurement Department, or, as the soldiers themselves referred to it, The Tin Noses Shop, was established.

The program’s founder, artist and sculptor, Francis Derwent Wood, described the effort, “My work begins where the work of the surgeon is completed. My cases are generally extreme cases that plastic surgery has, perforce, had to abandon; but, as in plastic surgery, the psychological effect is the same.” Wood and others fashioned lightweight, metallic masks to fit over all or a portion of the patient’s face. They were created from casts taken from the individual’s face and then painted to as close a likeness as photographs could get them.

These masks were uncomfortable and non-functional with regard to expression, talking, eating or anything requiring movement. For many, even with the mask, family and friends were never able to accept their appearance. But, for others, this effort made all the difference. One of Wood’s colleagues, American sculptor, Anna Coleman Watt, in writing about her experience, recorded, “The letters of gratitude from the soldiers and their families hurt, they are so grateful.” “Thanks to you, I will have a home,” one soldier had written her. “…The woman I love no longer finds me repulsive, as she had a right to do.”

How we look matters.

Article by
Englewood Facial Plastic Surgeon