A timeline of the made face
From enameled eyes and sixteenth-century noses to First World War portrait masks, bone anchors and digital design: more than twenty dated entries, each tied to a source we opened.
Replacing a face is older than most people expect and more entangled with surgery than the usual stories suggest. Surgeons and makers of prostheses worked on the same problem, often at the same time, and a field that now sits between dentistry, surgery and sculpture took shape through war, materials science and, lately, software. This timeline follows the made face through five eras. Each entry cites a source that was opened and read. Where sources disagree about a date or a number, the entry says so rather than choosing quietly.
Two cautions. Early history is thinly documented, and one review notes that the origin of maxillofacial prostheses is not clear. And these entries describe public history, not treatment: what suits any one person is for them and their clinical team. The materials story continues on materials, and the modern workflow on how a facial prosthesis is made.
Before the 1800s: eyes, noses and plates
Antiquity
Eyes, ears and noses in ancient evidence
A review in the International Journal of Dentistry gathers the early evidence. Mummified Egyptians were found with enamel-covered silver eyes with bronze lids, and with nasal and auricular structures, though the review stresses this does not mean they were worn during life. It says there is evidence the Romans used artificial eyes in life, and that evidence from China dated to the year 200 describes facial prostheses on a metal framework coated with lacquer to simulate skin tones. The only recorded case between the years 200 and 1000, it says, is the Byzantine Emperor Justinian II, who had a golden nose made while he was imprisoned.
About 600 BC
Sushruta describes rebuilding a nose with a cheek flap
On the surgical side, a 2021 history in Current Opinion in Otolaryngology and Head and Neck Surgery says Sushruta described using a leaf as a template of the wound and a cheek flap to supply tissue, dated by the article to 600 BC, and that he is called the father of plastic surgery for this. It is a reminder that reconstruction and replacement have always been parallel answers. The modern version of the choice is on prosthesis or reconstruction.
1541 and the 1500s
Pare and the first documented prostheses
The same dental-history review says that Ambroise Pare provided the first documented use of maxillofacial prostheses in the 16th century, mentioning artificial eyes, ears and noses and describing an obturator. His devices used papier-mache, leather, ivory, gold and silver, and a nose could be held on by sticky substances or linen strips round the head. A University at Buffalo history page dates his published obturator to 1541, quoting a plate of silver or gold with a small sponge that swells with moisture to hold the plate up in the palate.
1597
Tagliacozzi publishes the arm-flap method
According to the nasal reconstruction history, Gaspare Tagliacozzi of Bologna described the Italian Method, a delayed pedicled flap from the arm, in De Curtorum Chirurgia in 1597, which the article calls the first treatise devoted to plastic surgery. By then a nose rebuilt from the patient's own tissue and a nose made of papier-mache or metal were both on offer, which is the choice that still shapes the field.
1681
Enamel eyes made to look natural
The dental-history review reports that artificial eyes were being made of enamel in 1681 with the aim of looking natural, and that glass and wood became more common in the 16th century, when doctors in Germany and France debated which material was better.
The 1800s: porcelain, celluloid and vulcanite
1800s
Gold plates, a porcelain nose and new plastics
The International Journal of Dentistry review says that in the 19th century William Morton used a gold plate for an obturator and made an artificial nose of porcelain attached to the patient's glasses. Nitrated cellulose, discovered in 1867, was tried but turned brown and caught fire for smokers, and cellulose acetate did better. At the end of the century vulcanite, a hard rubber, was introduced and replaced cellulose, metals and ceramics for many uses.
1914 to 1919: the Great War and the portrait mask
1914 to 1918
A new scale of facial injury
The dental-history review reports that more than 600,000 soldiers had head and facial injuries in the First World War, that vulcanite was frequently used then to make maxillofacial prostheses, and that prosthetics helped recuperating soldiers take part in social life again. The surgeon Harold Gillies, a New Zealander working in London when the war began, later recalled in a quotation carried by Smithsonian Magazine: "we were suddenly asked to produce half a face."
1915 or 1916
Francis Derwent Wood opens the mask department
The sculptor Francis Derwent Wood enlisted in the Royal Army Medical Corps and, as an orderly at the 3rd London General Hospital, began making masks for men whose faces could not be repaired. His unit was officially the Masks for Facial Disfigurement Department and was nicknamed the Tin Noses Shop. Accounts differ on the start: Smithsonian Magazine says Wood established the unit in March 1916, while Forces News says he began the work in 1915. Smithsonian quotes him: "My work begins where the work of the surgeon is completed."
1917
The Lancet notices; Anna Coleman Ladd opens a Paris studio
Smithsonian Magazine reports that by June 1917 Wood's work had warranted an article in The Lancet, and that near the end of 1917 the Boston sculptor Anna Coleman Ladd, after consulting Wood, opened the Studio for Portrait Masks in Paris, in the Latin Quarter, administered by the American Red Cross. She worked with four assistants. Some sources give early 1918 as the opening; Smithsonian says late 1917.
1918
How a portrait mask was made
In Ladd's studio, according to Smithsonian Magazine, plaster casts were taken of the healed face and clay or plasticine copies made from them. The mask was galvanized copper about one thirty-second of an inch thick, weighing between four and nine ounces and generally held on by spectacles. Oil paint chipped, so Ladd used a hard, washable enamel with a dull, flesh-like finish, painting it while the man wore the mask so the color matched his own. A single mask took a month. Forces News describes the same overall sequence for Wood's department: a mold of the face, a clay or plasticine model, and finishing on the patient to match skin tone. The craft is discussed again on how a facial prosthesis is made.
1919 and after
What the masks could and could not do
By the end of 1919 Ladd's studio had produced 185 masks, Smithsonian Magazine reports. The number Wood produced is not known. The article says masks could not restore functions such as chewing or swallowing, that a mask had a life of only a few years, that Wood's department was disbanded in 1919, and that almost no record of the men who wore the masks survives. The magazine, not the wearers, tells the story; we have no first-hand accounts to quote.
1939 to the 1980s: units, silicone and anaplastology
1939
Specialized plastic and maxillofacial units
The dental-history review says researchers between the wars tried materials such as prevulcanized latex, that the growing number of war injured led to specialized plastic and maxillofacial surgery units in the United Kingdom and British colonies, and that the first was used in 1939.
1950s
Branemark and the idea of osseointegration
A review of implant-retained craniofacial prostheses credits the Swede Per-Ingvar Branemark with discovering in the 1950s that titanium is exceedingly biocompatible with bone and with coining the term osseointegration. Titanium dental implants followed in the 1960s. The idea of anchoring to bone, rather than relying on glue or glasses, is explained on bone-anchored implants.
1960s
Silicone becomes the standard material
A 2024 review in Materials says polydimethylsiloxane, the common silicone polymer, has been the most widely used maxillofacial prosthetic material since the 1960s, praised for skin-like flexibility, transparency and light weight. The review also reports that such prostheses have an average lifespan of approximately 2 years. The materials are covered on materials.
1971 and 1980
Anaplastology becomes a profession
A 2022 review in Frontiers in Oral Health says that, through Walter Spohn and Stanford University, anaplastology began as a formal training program in 1971, and that the International Anaplastology Association was founded in 1980 as the American Anaplastology Association.
1977 to 2000: bone-anchored prostheses
1977 and 1979
Titanium implants outside the mouth
According to the implant review, the ear, nose and throat surgeon Anders Tjellstrom made the first use of percutaneous titanium fixtures outside the mouth in 1977 for a bone-anchored hearing aid, and in 1979 for a bone-anchored prosthesis. The dental-history review likewise says osseointegrated implants have been used for maxillofacial rehabilitation since 1979.
1991 to 2000
Grid, plate and magnet systems
The implant review reports a grid system of thin titanium credited to 1991 and designed for areas with little bone, a plate system developed in 2000, and magnetic attachments in use since the beginning of the nineties, which it calls huge progress for cleaning and insertion in the nose and eye-socket regions.
2000 to today: scanners, software and printers
2000s and 2010s
Facial scanning enters the workflow
A 2022 review in Frontiers in Oral Health says colored facial scanning has become popular over the last 20 years and that structured light scanners entered facial prosthesis workflows in the past decade, with the first digital workflows built on MRI and CT data. The long tradition of plaster impressions began to give way. See digital design and 3D printing.
1901 and 2010
An astronomer's nose, tested
A news page of the National Museum in Prague reports that a green residue in the nasal opening of the astronomer Tycho Brahe was first described by Jindrich Matiegka in 1901, that his remains were exhumed in 2010, and that analysis found copper and zinc in the same ratio, indicating the prosthesis was not made from a gold and silver alloy but most likely from brass. The results were published in autumn 2012. The finding rests on analysis of residue, so it is an inference about the material.
2016
A phone camera as a face scanner
A paper in the Journal of Otolaryngology, Head and Neck Surgery presented a way to turn photographs from a mobile device into a 3D model of a face using free software, as a digital facial impression for making prostheses, and suggested it could improve access for centers without costly technology.
2021
A systematic review of digital planning
A review in the International Journal of Environmental Research and Public Health found 21 studies covering 23 patients in which digital planning was used for craniofacial implants and nasal prostheses. It reports that digital technology has been claimed to reduce clinical and laboratory time, with equipment cost as a limit.
2023
A trial planned to compare digital and conventional
A study protocol in Pilot and Feasibility Studies describes a feasibility trial in which participants receive two prostheses, one made digitally and one conventionally, and states that a well-designed randomized trial comparing the two is still needed. The made face is still unfinished business. For what it is like to wear one, see living with a facial prosthesis; for the basics, what a facial prosthesis is.
In brief
The record shows eyes, noses and palates replaced for centuries with whatever materials were at hand, surgery and prosthetics growing in parallel, a burst of invention during the First World War, silicone and titanium transforming the field from the 1960s and 1970s, and digital tools reshaping the process now. Many details of the early period are uncertain, and the evidence for the newest methods is still being gathered.