Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The operator will follow what method he pleases in filling his syringe,
but at no time should he fill it with the cooled product with a spatula,
or other such means, as he is sure to fill it unevenly in this way,
incorporating a number of air spaces. The air issues from time to time
during an operation with sudden sputtering outbursts, that not only tend
to annoy the patient, but also to frighten him—the shock being unusual
and unexpected, while the air thus forced into the subcutaneous tissues
puffs out the parts and interferes with a perception of the proper amount
to be injected and adds to the danger of air embolisms.
Slipshod methods are inexcusable, and should not be tolerated. The
best results possible should be given the patient, and only from the
best results obtained with the best care can the most reliable data be
attained, all helping to fix the reliability, efficacy, and exactitude of
this branch of cosmetic surgery.
THE PRACTICAL TECHNIQUE
The field of operation and the instruments having been properly prepared,
as described, the _modus operandi_ must next be considered.
Since the various parts of the face to be injected demand specific
procedure, they will be considered somewhat individually hereafter,
whereas the general technique, applicable in as far as the method of
injection is concerned and applying similarly in all cases, may tersely
be first taken up.
Various and noted surgeons point out that these subcutaneous injections
should be made under general anesthesia, i. e., ether, while others
consider the hypodermic use of cocaine or Eucain β solution in one to
four per cent necessary to accomplish good results.
The author considers the method in the first case objectionable both as
to patient and operator, entailing much discomfort to the one operated
on and demanding an unnecessary waste of time for the etherizing and
recovery. Likewise is the employment of a local anesthetic not indicated
or demanded, since the operation to be undertaken necessitates only the
pain associated with the prick of the needle through the skin.
The objection to etherization is obvious, while the hypodermic employment
of any local anesthetic, by the very fact of its presence of volume and
its physiological action upon the tissue, tends to interfere with the
proper injection of the parts by reason of temporary swelling of the
parts, not caused by the later injections of the prothetic mass.
If in nervous irritable patients an anesthetic is required to allay fear
it is best to use the ethyl-chlorid spray upon the skin sufficiently
to overcome the sharp sting of the needle insertion. For this purpose
the ether spray is used only to the point of blanching the skin, and no
longer.
This mode of procedure is especially useful when a number of injections
are to be made, as in the rounding out of a cheek or of the shoulders, in
which the contour cannot be restored from one point of injection, as will
hereinafter be described.
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