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The term facial reconstruction surgery conjures up images of pristine exam rooms and sterile equipment. While these perceptions are accurately evocative of the modern field of American plastic surgery, the procedures we know today actually go all the way back to the Civil War. While a myriad of advancements have been made in recent years, the earliest facial reconstructions occurred during a truly bleak time in our history, laying the framework for modern plastic surgery.

War Is Hell, Disease Is Death

While historians often focus on the impact of bullets and cannons when they tally the death toll of the Civil War, disease played a shocking role in making that number skyrocket. For every soldier killed on the field of battle, another two died from afflictions that couldn’t be treated by the medicines of the time. These diseases included typhoid, measles, diphtheria, and pneumonia.

Pneumonia was the malady that claimed 18-year-old Private Carleton Burgan. A foot soldier for the Union Army, Burgan had a persistent cold that got progressively worse. His doctor attempted to alleviate the condition by treating him with calomel, a formula that contained mercury intended to flush Burgan’s system. Instead, the toxins in his medication ate away the soft tissue in the young man’s mouth, nose, and jaw.

Burgan’s life was forever changed by the prescription of the mercury pills. His deteriorated flesh succumbed to facial gangrene, which spread from his tongue to his soft palate and cheek. Eventually, the infection spread to his right eye, leading to the removal of his right cheekbone to halt the life-threatening spread of gangrene.

The First Photo Documented Facial Reconstruction Patient

Burgan joined the ranks of thousands of Civil War veterans who were left disfigured and seemingly hopeless. But history would shine brightly on Private Burgan; he would not be yet another statistic. He would become the first documented facial reconstruction patient, a true benchmark in medical breakthroughs.

Traumatized and unrecognizable after the surgery to remove his gangrenous tissue, Burgan turned to City Hospital surgeon Dr. Gurdon Buck, now considered the father of facial reconstruction surgery.

Buck was the first to document “before and after” photographs of a reconstruction surgery, and it is through him that we have an idea of the capabilities of surgeons of this era. Because of the doctor’s intervention, Private Burgan, after several surgeries, was able to go on to enjoy a relatively normal life.

In fact, Burgan thrived beyond the war years. He got married, had several children, and lived to be 71 years old. He passed away in the year 1915, just as another quantum leap in facial reconstruction innovation would revolutionize the field of plastic surgery.

Advancing Modern Facial Reconstruction: The World War I Years

The techniques used to save Carleton Burgan formed the building blocks of the surgical techniques used in modern day facial reconstruction surgery. The 20th century actually saw many advancements in facial reconstruction techniques, and just as with the case of Dr. Buck and Carleton Burgan, war necessitated this new round of breakthroughs.

Dr. Harold Gillies established a visionary health practice in London during the First World War. He hired a team of nurses, surgeons and… artists? Dr. Gillies believed it would require a new set of aesthetics to repair the broken soldiers who had survived the horrors of the battlefield, so he brought in a sculptor named Kathleen Scott to join his efforts.

Ms. Scott made casts of the injured young men’s faces to work from. Then, using flaps of grafted skin and sections of rib bones, the surgical squad rebuilt the fallen soldiers’ faces by working from the aforementioned casts. Together, the team made significant strides in jaw reconstruction and replacement that would ripple forward through time.

Another World War, Another Round of Healing

The vanguard work of Dr. Gillies made waves around the globe, and news of his accomplishments soon made their way to New Zealand. A young med student named Archibald McIndoe sought out the tutelage of Dr. Gillies, who was, in fact, a distant relative of his. McIndoe joined forces with Gillies and became a leader in the burgeoning field of plastic surgery in London during the 1930’s… just before the world was on the brink of another disastrous war.

Just as technology advanced, so too did the weapons of battle. During World War II, many fighter pilots suffered from a phenomenon called “Hurricane Burn” – this was the result of jet fuel that had ignited during the heat of warfare. The traditional remedy for such disfigurements was tannic acid, which dried out the affected skin and caused additional pain and scarring to the already devastated victims.

Dr. McIndoe saw a better solution. He noted that pilots who had been shot down at sea suffered less severe trauma, so he decided to treat his patients with saline rather than tannic acid. This resulted in speedier recovery, less pain, and overall more successful rehabilitation.

But McIndoe wasn’t just a pioneer in the operating room (his work included the reconstruction of many soldiers’ hands in addition to his treatment of facial tissue damaged by burns); he also focused on his patients’ mental health post surgery. McIndoe encouraged those he had treated to form their own “Guinea Pig Club” – it was a support group intended to aid in the men’s reintegration into society following their harrowing experiences during the war.

To honor his place in world history, McIndoe earned a knighthood in 1947. He then went on to help found the British Association of Plastic Surgeons (BAPS), an organization that later elected him its president.

Various advancements over the years, and from all parts of the world, have led to the facial reconstruction techniques available today, and certainly, we can now do things at which Doctors Buck, Gillies, and McIndoe would be astounded by.

3-D Computer Imaging for Facial Reconstruction

Continuing with the trend of evolving technology, Dr. William J. Binder, considered as one of the founders of modern facial contouring, was the first to use 3-D computer imaging to develop facial implants for both aesthetic and reconstructive procedures. With the use of this technology, Dr. Binder can capture the minute details of a patient’s face and transpose those details into the implants, creating natural-looking and subtle results. In fact, these techniques are currently implemented by plastic surgeons around the world.

As a leading surgeon who thinks in terms of 3-Dimensional concepts, Dr. Binder is always on the forefront of technology. Stay up to date with his blog for intriguing insight into the field of plastic surgery and facial reconstruction.