Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The deformity is usually symmetrical, but where the nasal bones have been
injured as well, particularly where one bone is injured more than its
fellow, there is a possibility of the disfigurement being unilateral.
This is rarely the case except when due to punctured wounds; generally in
such cases the anterior nasal line assumes a twisted form.
Some operators have included noses of undue lobular prominence (à la
Cyrano de Bergerac) under this type of deformity, and while it is to
be admitted such a nose might be built up by subcutaneous prothesis
the result is anything but harmonious or normal. Such a nose should be
reduced by cutting operations instead of being added to. The seeming
depression above the lobule is only comparative to the overdeveloped form
of the lobule. The face values of every patient should be studied, and
the surgeon should never attempt to break up the harmony of facial form
by simplifying an operation and rendering the patient’s appearance even
more ridiculous than before his attempt to correct a fault.
The correction of the deficiencies of the lower half of the nose is
associated with difficulties in various directions. Either the skin over
the defect is too dense to render injection an easy matter, or the nose
is so broadened horizontally from the original injury that the injection,
no matter how artistically done, leaves the nose bulky and ugly in
appearance.
When the nasal processes of the superior maxillary bones have not been
widened unduly by an injury and the skin is dense, simple subcutaneous
dissection before injection will overcome the difficulty easily enough.
In that case the needle is inserted laterally in a line with the maximum
depth of the depression and the point shoved up to the median line
anteriorly.
Enough of the cold mixture of paraffin and vaselin, as heretofore
advised, is injected to reduce the deformity nearly to the normal.
The mass is molded to give the nose as near a normal contour as possible,
always keeping in mind the later broadening of the nose when the new
connective tissue has taken the place of the injected mass. A later
injection made, as advised heretofore, will restore the anterior line to
better form.
If the nasal processes of the superior maxillary bones have been thrown
outward considerably a surgical operation is necessary to reduce them.
No injection should be made until the wounds from such operation are
thoroughly healed and contracted.
In all cases of this type the skin will be found to be rather dense and
likely to be tied down by past inflammations to the anterior aspects of
the lower lateral cartilages at their juncture with the upper lateral
cartilages. If the adhesions are not too dense the harder form of the
cold mixture should be used. This will not only permit of raising the
skin more readily than with a softer kind of mixture, but will be more
likely to retain its form under the contractile pressure brought to bear
down upon it.
Public-domain text, read in full here on John Shaqi.
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