Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Since the skin is rather firmly adherent at the sides of the nose,
except in the major part of the superior third, it will be found best to
raise the skin of such defect into normal contour by a series of very
small injections instead of following the method heretofore advised in
connection with tense or adherent areas of skin, for the reason that such
dissection would render the skin too mobile over an area usually beyond
the defect itself and inviting the surgeon to an annoying hyperinjection
which renders the part more unsightly than prior to the operation. This
is true in most cases unless the depression is of traumatic origin and
beyond the size of deformity usually corrected.
The author advocates the employment of a hypodermic needle attached to
the syringe in place of the regular needle and that the injection be of
sterile white vaselin without additions of any kind.
Such injections may be made very readily, one or more at the first
sitting, being introduced below the deepest part of the defect. It
is surprising how much four or five drops of such an injection will
accomplish. Furthermore, it is to be remembered that the injections about
the side of the nose are readily replaced by new connective tissue, equal
to, if not commonly greater in amount, than the mass injected, such
growth being completed in about two months after the time of injection.
This may be explained by a more or less active perichondritis when the
injection is made over the cartilage, the inflammation, thus set up,
being of longer duration than where the skin and bone or areolar tissue
are involved. Any subsequent injection should not be undertaken until at
the end of two weeks or more for the reasons above stated.
The injected mass at all times should be introduced under normal
pressure, never to the extent of rendering the skin above it white in
color. The mass should also be molded out with the tip of the finger or
the rounded, dull handle end of a scalpel. If necessary, the small finger
may be introduced into the nostril to facilitate this molding. Should
the reactive inflammation be severe such remedial agents as have been
referred to should be used to reduce it.
Phlebitis following injections at the side of the nose is due entirely to
the injection of a blood vessel and must be avoided. When a fine needle
is used there is less likelihood of free bleeding from an injured vessel,
therefore a thorough knowledge of the usual position of the vessels about
the sides of the nose is absolutely essential. Bleeding of greater extent
than that which would follow the thrust of the needle through the skin
should put the surgeon on his guard. Experience is the better teacher and
conservatism in these ofttimes delicate, subcutaneous operations will
save the surgeon much annoyance and eventually the need of having the
patient submit to a cutting operation to reduce an overcorrected area.
Public-domain text, read in full here on John Shaqi.
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