Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The correction of this class of deformities may be accomplished by
carefully raising the depressed area by repeated injections of small
quantities, always avoiding the frontal and supra-orbital vessels.
At no time should such a deformity be corrected in one sitting, unless
when the defect is a congenital one of small moment.
The reaction following these injections, owing to the close attachment of
the integument to the bone, is usually found to be more severe than where
the skin is more loosely attached.
In traumatic cases the scar attachments should be freely liberated, under
eucain anesthesia, by the aid of a fine probe-pointed tenotome, before
the cold paraffin mixture is introduced.
In such event only one opening should be made and just enough of the
mixture be injected to raise the skin to its normal contour, if this be
possible. Generally, later injections are required, and these may be
made without further dissection. They should not be undertaken until the
incised wound made with the tenotome has healed thoroughly, otherwise
the pressure of the injection is liable to burst through the delicately
healed wound, and thus delay if not endanger the success of the first
operation.
When the reaction following such injections be severe, associated with
considerable edema, cold pack or ice cloths should be applied or resort
may be had to hot applications of antiphlogistin. The patient should be
kept on his feet during the day and sleep with the head high at night.
The bowels should be kept open, and general tonics be given if indicated.
The patient usually returns to the normal, except for a little tenderness
about the forehead, in three or four days under the treatment outlined.
DEFICIENT OR RECEDING FOREHEAD
In this condition there is usually a transverse lack of contour across
the forehead above the superciliary ridges, giving the patient a
degenerate appearance. The defect is congenital and is to be corrected,
as described in the foregoing division, although the injections may be
at either outer or temporal end of the forehead, gradually being brought
nearer to the median line until the contour of the whole forehead has
been raised by subsequent injections.
UNILATERAL DEFICIENCY
This defect may be traumatic—the result of direct violence, but is more
commonly due to a frontal sinus operation.
In both events it will be found necessary to detach the cicatrices that
bind the skin down to the injured bone, before a prothetic injection may
be undertaken.
In some cases where the cause of the deformity has been moderate and
the scar is linear and of long standing the injection may be undertaken
without subcutaneous dissection.
Several injections are necessary, as the tissue about such parts is
usually much thickened, apart from the firmness added by the scar tissue.
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