Surgery of hope: story of plastic surgeons helping military return to life

Ancient times: cut off noses

The first plastic surgeries were performed in ancient Egypt and India.

There is a treatise written more than 1,500 years before Christ in which the Egyptians described how to treat injuries. Interestingly, 30% of the treatise dealt with the absence of a nose. It turns out that in those days, in order to psychologically destroy a person, they cut off a person’s nose. This was the punishment for various crimes, including adultery.

Therefore, nose restoration was in demand. Ancient Indian Surgery to correct the shape and size of the nose, as well as congenital and acquired nasal defects.rhinoplasty involved the transplantation of skin from the forehead or cheek to the damaged nose. The doctor cut out a small flap of skin, leaving a “leg”. Then he turned it over and applied it to the damaged nose. The flap was fed by the blood vessels in the “leg” until it grew to a new location.

The British historian Arthur Basham's book The Wonder That Was India states: “…plastic surgery was developed far beyond anything known elsewhere at the time. Ancient Indian surgeons were expert at the repair of noses, ears and lips, lost or injured in battle or by judicial mutilation. In this respect Indian surgery remained ahead of European until the 18th century, when the surgeons of the The British East India Company was an English private company engaged in trade with the East Indies and China, which existed from 1600 to 1858.East Indian Company were not ashamed to learn the art of rhinoplasty from the Indians.”

In the 15th and 16th centuries, Italian surgeons used a method similar to the Indian one. To form the nose, they took skin from the arm, not the forehead or cheek. The patient had to keep his arm near his head for 15-20 days! Only then could the “leg” be cut off.

“Both methods are absolutely suitable for our time. I have tried both, but the Indian method is better, because walking with a raised arm is long and uncomfortable. The Indian method is considered the gold standard. The Indians are generally advanced: they used flax threads and animal tendons,” says Dmytro Slosser.

According to him, plastic surgery was not recognized by the church for a long time. They say that a person is as he or she is by the will of God, so there is nothing to change. Because of this, for example, in Italy, surgeons were considered criminals and buried on unconsecrated ground along with suicides.

The situation changed when, in the 20th century, Pope Pius XII said that he approved of plastic surgery because it heals not only the body. It also heals souls.

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Wars of the 20th century: masks and drug addicts

In the last century, the World Wars I and II left many young soldiers with disfigured faces. An explosive artillery shell filled with bullets.Shrapnel turned them into a bloody mess. Because of this and the horrific injuries, the wounded committed suicide.

But every war gives impetus to the development of medicine. The leading surgeon of World War I, New Zealander Harold Gillies, was groping for a way that would combine functionality and aesthetics by trial and error. He said that a doctor with a scalpel should be like a sculptor, not a plumber.

Things were difficult in his time, given that antibiotics had not yet been invented, and opium was used for pain relief. This made some patients addicted to drugs. However, during the military campaign, Gillies performed more than 11,000 operations and became such a pro that he sometimes had to prove that the perfect noses he created were real, not fake. This is because masks made by sculptors for the wounded, which accurately reproduced facial features, were gaining popularity at the time.

“When I look at the results of this doctor's plastic surgery, I think they are beautiful. And more than a hundred years have passed! Many modern plastic surgeons in Ukraine would be happy to get such a good aesthetic effect,” notes Dmytro Slosser.

Severe wounds, frostbite, burns, fractures, and nerve damage the soldiers suffered during World War II led to plastic surgery becoming a separate medical speciality. From the 1940s to the 1970s, a huge number of unique methods of plastic correction were developed in the United States and Europe.

In the former USSR, there was no separate specialty of plastic surgeon until the 1990s. There were a kind of beauty institutes where skin imperfections were treated. Ordinary surgeons could reduce the abdomen by performing some kind of surgery. Rhinoplasty (nasal fractures and birth defects, such as lop-earedness) was performed by ENT doctors.

He knows how to ‘build’ an ear and a nose

Dmytro Slosser graduated from Lviv Medical Institute with a degree in surgery. He received his plastic surgeon training in the early 2000s in Israel.

“When I returned to Kyiv, I approached a well-known plastic surgeon and said: ‘I want to work in the capital, but there is an offer to go to Moscow.’ He replied: ‘Go to Moscow, it's better there.’ Later I realized that he wanted to get rid of a competitor. So I was stuck in Russia for 12 years.”

In the midst of the Revolution of Dignity, Slosser returned to Ukraine at the call of his heart. He performed surgeries to improve appearance. He was invited as an expert to the television projects “Give Me Back My Beauty,” “I'm Ashamed of My Body”, “Ukraine Speaks”, and others. At the same time, he was engaged in reconstructive surgery, namely ear reconstruction. These are unique operations that no more than 100-120 specialists in the world can perform.

Dr. Slosser was the first in Ukraine to perform ear reconstruction using the Japanese method, which gives the best aesthetic result. He cut out a frame for the ear from four ribs.

“As a child, I was fond of wood carving. This is similar,” the doctor jokes.

The frame was inserted under the skin, and the patient walked around with it for six months while his ear was forming. Then the frame was removed.

Over time, Slosser's specialty became nose reconstruction. Out of about 200 plastic surgeons in Ukraine, he had the most experience in this field. Before the full-scale war, Slosser mostly restored noses with birth defects or those bitten off by dogs. But thanks to the experience he gained in Israel, he was able to operate on war injuries as well.

“I had a good practice in this country,” he says. “There are no military hospitals there; there are hospitals that operate on MPs, homeless people, and military personnel. That is, there were different patients. In addition, I was there at a time when buses were being blown up in terrorist attacks, and the wounded with combat injuries were brought directly to us.

I encountered such a variety of injuries that it gave me a head start over my colleagues in Ukraine after the full-scale invasion. They knew how to perform specific aesthetic surgeries, but unfortunately, not reconstructive ones. So I decided to use my knowledge to help our military.”

How to make something out of nothing

Slosser notes that the current Russo-Ukrainian war differs from other wars in the nature of the injuries. The injuries are more traumatic, requiring more complex treatment and long recovery.

“If there is a combined trauma, the first thing to do is to save the patient’s live. This is the job of surgeons and traumatologists. Plastic surgeons come on the scene at the end, because plastic surgery is not the most necessary thing, although it is important psychologically. This happens about a year after the injury. That's why at the beginning of the great war we operated less, and now we have at least one operation per week,” says Dmytro Slosser, who works at the Nove Tilo aesthetic surgery clinic in Kyiv.

Military personnel with nasal injuries are mostly referred to him by their colleagues. But there are also those who come directly on their own. The surgeries, which cost 25-30 thousand dollars abroad, are performed free of charge. The clinic covers these costs from the income it earns from regular aesthetic surgery.

Rhinoplasty takes place in several stages (there can be 6-7 of them) with an interval of several months. Surgeons need to make the nasal framework (cartilage is taken from the ribs or ears), line the inner mucosa, and cover it with skin (taken from the forehead).

“It's easier to make less out of more, and harder to make more out of less (or when there is nothing at all),” Dmytro sighs and shows photos of patients before surgery.

Some of them had their noses crushed by the debris. In the photos after the operation, healing and restoration, the noses seem to have miraculously appeared on the face. According to the plastic surgeon, it is impossible to fully restore the nose as it was before the injury. However, specialists try to make it as similar as possible.

“The most important for the nose not to attract attention, not to catch the eye, and to functions well. All our patients are happy.”

In his comment to hromadske, 31-year-old Illia Pylypenko, a veteran of the Russo-Ukrainian war, confirms these words. He was a tank driver, and during the 2022 offensive on Kherson, he drove onto a mined road. The tank exploded, and Illia couldn't get out of it right away, so his arms, legs, and face were severely burned.

“Later, the wounds healed, but my burnt nose was very deformed. After I had undergone general treatment and had my leg prosthetized, I was looking for a doctor who could do something about my nose. Strangers were staring at me, I felt insecure, and my self-esteem dropped. My dermatologist assured me that there was no one better than Dmytro Slosser in our country,” the soldier recalls.

He looked for the plastic surgeon on social media and looked at his work. He liked them.

“I saw that he had shaped a guy's nose from scratch. I made an appointment for a consultation, and we started this journey. Gradually, a picture which I like began to form. This affects my self-esteem, my state of self-satisfaction,” says Illia, who says that his friends think his new nose is prettier than his own before he was wounded.

If any of the fighters need another surgery, such as restoration of the jaw, lower lip or eyes, the team involves specialists in these areas of reconstructive surgery.

“There are many people in Ukraine who want to do something useful. These are not only volunteer surgeons. I know a lot of cosmetologists and dermatologists who treat scars in their clinics for free. There are pharmaceutical companies that provide drugs for such treatment. That is, doctors are open to helping the military,” says Dmytro.

He is convinced that the mission of plastic surgeons now is to return our heroes to normal life as much as possible.

“One fighter lost two legs. In Lviv, we made him prostheses, reconstructed his eye and nose. And he is so inspired that he is rushing back into battle.

Another recently wrote that after our operations he recovered, got married and is happy. I am happy to hear such stories and want to help people even more,” the surgeon says.