Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
If a liquid paraffin or hydrocarbon mixture or vaselin is used, the
immediate use of ice cloths applied to the part as digital pressure is
removed, is advisable to aid in the rapid hardening or setting of the
injected mass before the tension of the tissues over and about it might
influence it. With semisolid injection this is not necessary, except
in the subsequent treatment, as will be considered later, because the
mass, unless of too soft a consistency, as, for instance, vaselin, will
practically remain as injected and molded.
Vaselin when injected into tissue where there is tension would naturally
be forced out of position and shape, and should not be used except in
combination with a paraffin of a melting power high enough to give the
proper consistency to the former.
=12. Interference with Muscular Action of the Wings of the Nose.=—That
nasal respiration may be encroached upon as a result of injecting
paraffin about the nose has been observed by Alter. He points out that
during nasal inspiration there is a tendency for the alæ to contract
upon themselves or to move inward, decreasing the lumen of the orifice,
and that in the normal state this movement is counteracted by the action
of dilator muscles of the alæ—that is, the dilator naris anterioris,
the pyramidalis nasi, and the levator labii superioris alæque nasi—and
that this muscular action is interfered with owing to the pressure of
the paraffin upon these delicate structures, and resulting in more or
less permanent collapse or indrawing of the alæ during inspiration. He
observed considerable interference with inspiration in a case cited in
which an injection of paraffin had been made.
To avoid undue pressure upon the structures referred to, it is advised to
have an assistant place a thumb into each nostril and the index fingers
without and above the alæ in such way that the tips of the fingers may
be enabled to exert the necessary pressure over the injected mass into
these structures, and to maintain this pressure until the mass has been
properly molded and set. Connell advises inserting the little fingers
into the nostril to prevent an encroachment on the lumen of the nasal
canal.
The above applies particularly to those cases where injections are made
into the anterior lower or lateral third of the nose, as, for instance,
in overcoming slight depressions in the anterior line, immediately above
the lobule or in a low unilateral deviation of the nose.
=13. Escape of Paraffin after Withdrawal of Needle.=—When the injected
mass employed is of a semisolid consistency, as heretofore advised, it is
hardly possible for the mass to be forced out through the opening of the
skin made by the introduction and withdrawal of the needle, unless there
be an unwarrantable immobility of the skin above the site to be injected.
The latter should be corrected before injection.
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