Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The author prefers making a plaster cast of the entire nose which is to
be corrected, and a second cast after the operation has been completed,
or at the time of his discharge. A record sheet, or a direct photograph,
can be made before and after operation for the same purpose, which is
not so desirable, however, because it has been found quite impossible
to procure the desired accurate pictures of a nasal deformity, the
photographer not being given to bringing out imperfections as the surgeon
wishes them, even under the most explicit instructions, unless the
surgeon accompanies the patient to the studio to supervise the posing.
This requires a waste of valuable time; not to speak of the expense of
making pictures of a pathological nature. The better way would be to have
an apparatus in the operating room. The surgeon can then pose his patient
against a screen background in the position and to the size of picture he
may desire. Plate cameras and time exposures are best for this purpose.
For recording and half-tone reproduction silver prints are found best.
For all deformities of the anterior nasal line a hydrocarbon compound
of the higher melting points should be used. This should be injected
in the cold form. The mixture given on page 39, with perhaps an added
half dram or dram of paraffin, has been found excellent, the addition of
paraffin being made to assure a suitable fineness of contour and width.
The softer mixtures are more liable to cause a lack of contour and a
consequent widening of the part injected, even after molding, because of
the contractility of the skin overlying the injected mass, which tends to
flatten it out, giving the nose a less artistic and delicate appearance.
Furthermore, a soft mixture will be found to be inefficient in overcoming
the tension of the skin in most cases, especially those about the middle
third of the nose.
In some cases of lateral deformity, and where otherwise mentioned, it
is advisable to use only a mixture of the lower melting points, as in
the case in the correction of interciliary furrows and temporal muscular
deficiency.
=Superior Third Deficiency.=—The degree of depression about the superior
third or root of the nose varies considerably. The most extensive form
may be commonly found in the negro nose, where there is almost an absence
of a rise in that part of the nasal bones. Such noses are also found in
the Chinese and Japanese. The condition ofttimes may be associated with
epicanthus.
Epicanthus, formerly corrected by an elliptical excision done anteriorly,
can be entirely overcome by the subcutaneous injection method, thus
not only avoiding the resultant linear cicatrix, but building up the
depressed nose to its normal contour.
The skin overlying most of the defects of the superior third is usually
found to be loose, hence injection is readily accomplished.
[Illustration: FIG. 292. FIG. 293.
ANTERIOR SUPERIOR THIRD NASAL DEFICIENCY AND CORRECTION THEREOF.]
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