Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
In those conditions where loss of tissue is responsible for the defect,
as in the extirpation of neoplasms, ulcerative disease, etc., it is
quite likely that cheiloplasty is required to rebuild the parts, but in
many of these cases splendid results may be obtained by the judicious
use of hydrocarbon protheses to overcome the usual post-operative
oral distortion. It is understood that such injections should not be
undertaken until the wounds are thoroughly healed and the cicatricial
union fully contracted. This is true also in harelip operations
undertaken later in life.
The correction of labial defects coming under this method is not at
all difficult, but artistic skill and judgment are as necessary as the
surgical technic.
The lips are plentifully supplied with blood vessels, and therefore
greater care in injecting a foreign mass into their structure is
necessary; furthermore, the lips cannot be placed at rest for any long
period of time, so that the mass injected can never be expected to be
kept in place if of a consistency hard enough to permit the contraction
of the orbicularis muscle to move it about.
From the very fact of this practically constant movement of a part it is
self-evident such hard mass could not be retained or held in position for
any length of time, unless the mass is small enough not to be affected
by the movement, and under such condition the correction of a defect as
desired by the patient would require perhaps months to accomplish, owing
to the very fact that only droplike masses may be deposited under the
skin in perhaps a half dozen places with the necessity of a long period
of rest until the injections have been replaced by the new tissue before
the next operation could be undertaken.
It is absolutely absurd to think of injecting a lip with hard paraffin
liquefied by heat and expect to obtain a satisfactory result. While it
is true the mass is moldable immediately after its introduction, so
that a desired shape may be obtained, it does not overcome the fact,
however, that the mass must harden, as it will, and that, while a part
of it is broken away, as it were, from the mass proper, there is a
nuclear contraction as the hardening takes place, thus overcoming partly
the molded form; furthermore, the movement of the parts here tends to
displace the mass. Unequal muscular contraction breaks up not only the
form but also the mass itself, during all of which time it is made to
act as an irritant by virtue of the movement of the uneven edges of the
paraffin upon the adjacent tissue.
Furthermore, the presence of paraffin and the resultant mass of new and
hard connective tissue, so well recognized by all experienced surgeons,
is not desirable in the lip structure; it makes the lip appear bulky and
hard and anything but natural.
Public-domain text, read in full here on John Shaqi.
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