Tin masks to fixed faces: plastic surgery's debt to World War I

Modeling of patient for reconstruction of face at Walter Reed General Hospital.

Viewers of HBO's Boardwalk Empire know the character Richard Harrow,  a disfigured World War I veteran who wears a tin mask over part of his face to disguise his injuries. Others with facial wounds were aided by the development of modern plastic surgery, which aimed to rebuild faces shattered in warfare. While the term plastic surgery today conjures up images of bodies and faces belonging to movie stars and models, it was the horrors of war that stimulated developments in this medical arena. And it was an Armenian-American dentist, Dr. Varazstad H. Kazanjian, who deserves much credit for the specialty's birth.

This year is the centenary of World War I and many events are marking that occasion, especially in the United Kingdom. The National Museum of American History has an online exhibition on Americans at War that discusses American entry into the “Great War” in 1917. To honor that centenary, the National Library of Medicine will open an exhibit in 2017 featuring the experiences of patients and practitioners at the military hospitals in World War I. The medical history of World War I is one marked by an almost unfathomable loss of life and human suffering–and also by some medical and social developments, such as an effort at rehabilitation that emerged as the fighting continued and in its wake.

Eight and a half million lives were lost in World War I; more than 21 million people were injured. It was a conflict marked by the use of deadly gasses, the horrors of trench warfare, the killing power of the newly developed machine gun, and other new weapons–and it concluded amid an influenza pandemic that took the lives of between 20 and 40 million more. (By the way, have you had your flu shot this year? You still can!) With numbers like these, and so many horrific battlefield injuries and illnesses resulting from the dreadful trench-living conditions, it is little wonder that the development of modern plastic surgery and its efforts to aid those disfigured by war has received little public attention.

Varaztad H. Kazanjian–an Armenian immigrant trained in dentistry and beginning his medical studies when World War I began–joined the Harvard Unit at Base Hospital No. 22 at Dannes-Camiers, France. (Base hospitals were part of the casualty evacuation chain leading from casualty clearing stations at the front to military hospitals receiving the injured in the home country.) During the war, Kazanjian demonstrated his skill at facial surgery, using his knowledge of dentistry to repair wounds, and he rose to become head of the Maxillofacial Treatment Center at the hospital. After the war, he completed his medical training and continued to work as a surgeon, becoming the first professor of plastic surgery at Harvard Medical School, where he developed new techniques for treating facial wounds and birth defects. Kazanjian received many honors during a long and distinguished career.

Today, plastic and reconstructive surgery involves treatment of birth defects, injuries, wounds, and other conditions, as well as measures designed to enhance one’s physical appearance. It can be a source of humor to some who want to mock presumably shallow and vain individuals undergoing numerous cosmetic procedures in fear of aging. But appearances do lead to judgments, something war veterans faced upon returning to civilian life.

Let’s not forget that the foundations of this specialty were built behind battlefield lines, and the goals of these medical practitioners were to replace the tin masks of survivors with something better.

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