Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The vaselin in cold state should be injected directly under the skin
overlying the deepest point of the cleft and be slowly continued until
the lobule assumes its normal contour. The puncture may be made below the
point of the nose.
One such injection usually suffices to correct the fault. The reactive
symptoms are not severe if proper technic has been applied, and cold
compresses usually relieve it within twenty-four hours.
Should the skin be adherent about the anterior aspect of the lower
lateral cartilages, it can be forced away with a small, dull,
round-pointed knife resembling an eye spud, the opening for which need
not necessarily be greater than that made for the needle. The latter
is inserted through the same opening, which must be closed over in
this event with a drop of contractile collodion into which aristol is
introduced with the pulverflator, which not only embodies an antiseptic,
but at the same time hastens its hardening.
=Alar Deficiency= _(Unilateral and Bilateral)_.—The contraction about the
nasal rims may be due to hereditary causes or the result of intranasal
disease. The defect is usually bilateral, involving the entire alæ or
only their lower half or third.
The fault should be corrected by several injections made along the rim
of the nasal wing, using a fine needle, preferably of the hypodermic
size. Vaselin only should be used and two or three drops, according to
the extent of the deformity, be injected into the cellular tissue at the
point of each needle insertion.
Three of such punctures may be made along the rim, one beyond the other
in each wing. According to the defect the injection may be carried
higher or lower above the margin of the rim by shoving the needle upward
and toward the inferior border of the lower lateral cartilage.
The reaction in these cases is very little, rarely necessitating other
than an antiseptic powder-plaster dressing. Subsequent injections should
be made if the first do not give the desired contour; but never until the
surgeon is satisfied that the resultant new connective tissue thrown out
has reached its ultimate growth.
The harder paraffins, especially those injected in the liquefied state,
are not to be tolerated for the reasons given with the preceding method
of correction.
=Subseptal Deficiency= _(Partial and Complete)_.—It is not uncommon to
find a marked concavity of the subseptum in noses that have sunken in by
reason of intranasal disease or traumatism.
This concavity, when partial, is usually most marked near the lobule,
but in the complete variety the upward curve may be greatest near its
juncture with the lip.
Owing to the usual adhesions formed during the inflammatory period
causing the deformity the correction of this defect is quite difficult.
As a rule, the skin of the entire subseptum needs to be dissected away
from the underlying structure before it will permit of correction by the
injection method.
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