Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
ANTERIOR INFERIOR THIRD NASAL DEFICIENCY AND CORRECTION THEREOF.]
The defect should not be corrected in one sitting, for the very reason
that some widening of the nose may take place, owing to the contractility
of the skin, post-operatio.
The mass injected should correct the major part of the defect and be
molded out carefully, especially from both sides of the nose, and the
patient be instructed to pinch the nose laterally several times a day
after the reactive inflammation has subsided with the object of keeping
the nose as narrow as possible.
After the mass has been thoroughly replaced with connective tissue and
the anterior line is found to be too depressed, a fine line of the mass
about the thickness of the needle may be injected over it in a vertical
direction, the point of a fairly large needle being introduced just above
the anterior aspect of the lobule and thrust upward to the superior
border of the now existing deformity, and be slowly withdrawn as the mass
is injected.
This will leave a rounded cylindrical-like mass along the anterior nasal
line, which must not be molded at all, except to soften or shade off the
superior and inferior extremities.
The author advocates making two such injections, at the same sitting,
when the deformity has persisted. These injections are made parallel to
each other with a distance of about one eighth inch between them.
The subseptal deficiency will also have to be corrected. This will be
referred to later under its separate division.
The reaction in cases of this type is usually more severe than those just
mentioned. There may be considerable swelling and discoloration, but by
following the methods of treatment laid down heretofore the symptoms
usually subside in two or three days.
=Superior Half Deficiency.=—In this type of deformity there is found
a nondevelopment of the bridge of the nose, while the greater part of
the cartilage of the septum and the lower lateral cartilages seem to be
quite normal in contour. The nose has a dished appearance, with an undue
prominence of the nasal base or lower half.
Various causes may be given to this condition, but heredity is
responsible in a great majority of the cases.
The deformity in the type under consideration rarely takes in an accurate
half of the nose, there being an involvement more or less of the lower
anterior half, yet it is sufficiently distinctive to give it specific
classification.
For the correction of the defect in such cases the injection is made
laterally, the same mass being employed as in the preceding cases.
In this type of case the mass injected should quite correct the defect
and be molded with great care to a desired contour, keeping in mind
always the condition and elasticity of the skin overlying it.
An inflexible skin should be rendered mobile by digital massage,
practiced for a few days prior to operation, or in tense conditions be
loosened by subcutaneous dissection.
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