Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The injection should be made slowly and continued until a tumor, judged
to be sufficient to overcome the major deformity when molded out has been
formed.
This knowledge can only be gained by experience, and the operator must be
cautioned to underinject rather than cause undue prominence of that part
of the face.
If, however, his judgment has not been accurate enough, the operator can
immediately thereafter squeeze out enough of the filling to give him the
desired correction.
If more than a single furrow is to be corrected, he may inject the two
center ones, leaving the outer for later operation.
In multiple furrows the injections must be made in conelike form, to give
a normal contour to the forehead. The apex of such cone corresponding to
a point at the root of the nose, and the base to an arc with its greatest
convexity near the median hair line of the scalp, depending upon the
length of the furrows.
The injections in such cases should be made at least three days
apart, two being made at each sitting, after the central or two inner
depressions have been raised by the first operations. These later
injections should be made to relieve the furrows lying next to the
median, gradually working out to each slant side of the cone until the
contour of the middle forehead has been made normal.
Never superimpose an injection about the median line until the major
defect in general has been overcome, and only then when the first
injections have become settled and organized, as such untimely
disturbance is liable to set up considerable reaction, with enough
induration and resultant new connective-tissue formation to cause a
decided lumpy or protuberant appearance of the part.
The mixtures of low melting points should be preferred to the harder
variety in frown corrections. They lend themselves to better molding, and
seem to undergo organization with less pathological change than those of
the latter class.
When the injections must be made over the inner third or half of the
eyebrows, as is often the case, they should be made well above the hair
line and molded out in an upward direction, to avoid the dropping down
of the mass into the upper lids or to prevent the resultant displacing
connective tissue from involving them.
If the upper lids do become involved, as shown by fullness, hardness, and
partial ptosis, the connective tissue causing the same must be carefully
cut out from the lid by a transverse semicircular incision made in the
upper lid along the line of its backward fold or hinge. If need be, an
elliptical strip of the skin of the lid may be removed at the same time
to give better scope to the extirpation under consideration.
The author has recently corrected two such cases where a surgeon had
hyperinjected the entire forehead with a combination of oils at one or
two sittings. The resultant involvement and later discoloration of the
lids at the end of a year’s time might have been expected.
Public-domain text, read in full here on John Shaqi.
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