Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
For the latter reason repeated small injections have been advised, but
the author believes oft-repeated injections of paraffin in a small area
are prone to set up considerable disturbance, and that the resultant
tissue replacement is interfered with. Furthermore, the injected mass
would eventually be in grape-bunch like form, and in that condition not
as manageable or inducive to the establishment of contour angulation,
such as is required in the chin. The final appearance of chins thus
rebuilt is heavy and rounded, lacking the concavity above the inferior
prominence along the anterior line as well as the angulation laterally.
With the cold mixture advised a considerable mass may be injected at one
sitting, which is easily molded into form and which retains that form
unless the reactive inflammation is severe. This should not follow unless
actual hyperinjection has been done or an unclean product has set up an
infective cellulitis.
When the chin is uncommonly peaked, or small, it may be found necessary
to inject both sides of the chin beyond the angle and in an upward
direction slightly below and following the external oblique line.
Such deficiency may be found decidedly unilateral as a result of lack
of development of one half of the lower maxillary bone, a resection of
either maxilla for whatever cause, imperfect union following fracture or
disease of the bone early in life.
In such cases the lateral deficiency must be first restored, using the
same method, before the chin proper can be built up. Ofttimes the lower
cheek of the affected side must also be injected. This should be done
after the site overlying the former body of the maxilla of the affected
side has been rebuilt. The cheek should then be built out above this
hard linear mass by the injection of cold white vaselin, as heretofore
referred to.
The following illustrations show a chin deficient anteriorly and
laterally before and the result after correction.
The post-operative treatment should be collodion dressing, followed
by cold antiseptic applications for at least two days. The latter
ameliorates the inflammation and helps to retain the molded shape of the
mass. Subsequent sittings may be made one a week or ten days apart.
DEFORMITIES ABOUT THE EAR
=Pro-auricular Deficiency= _(Unilateral and Bilateral)_.—A deep furrow
in front of the ear may be found unilateral in hemiatrophy of the face,
but the condition is usually a bilateral one, due to malnutrition or the
fatty degeneration of past middle age. In the latter case the depression
is accompanied by a redundancy and wrinkling of the skin.
Owing to the close proximity of the large temporal vessels a hard mass
should never be injected subcutaneously for the relief of this condition.
Even the mixture of vaselin and paraffin has caused considerable reaction
when injected to overlie these vessels.
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