Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Deficiencies about the base of the neck and the shoulders are very
commonly found in women. These defects are usually bilateral, except
in rare cases. The much-desired contour is readily restored by the
subcutaneous-injection method, and since the technic for one part is the
same as for the whole there is no need to dilate specifically upon the
treatment of each part.
The author advocates the injection of cold sterile white vaselin
only, for the restoration of the contour about the neck, anterior and
posterior shoulder, and the mammæ, except in the unilateral correction
of a flattening of the breast following amputation for the removal of
neoplasms, when the mixture of white vaselin and paraffin should be used,
owing to the tenseness of the skin following the excision of a large part
of the integument covering the diseased gland.
In the restoration of the contour about the neck and shoulders it
is well for the surgeon to familiarize himself thoroughly with the
superficial veins of the parts, since the vessels here are larger, and
the introduction of foreign matter into them is liable to lead to serious
and even fatal results.
The injections should never be made until the operator has assured
himself of the fact that a vessel has not been entered into, and then
only should a small quantity of the mass—i. e., about two or three
drams—be injected at one point.
The easiest mode of introducing the needle is to pinch up the skin
between the fingers of one hand, introducing the needle into the fold
thus raised. As the mass is injected the skin should be raised by aid
of the needle, so as to allow all the immediate room possible for its
reception.
The mass injected is at once molded down flat with the thumb or
forefinger.
A number of such injections may be made at both sides at the one sitting.
The ethyl-chlorid spray may be employed to render the parts less painful.
At no time should the entire shoulders be filled at one sitting, for
fear that the reaction may be severe or that for any unforeseen cause
infection results which would in such instance be indeed difficult of
treatment, eventually leaving the parts scarred and unsightly.
Nor should the mass be injected intracutaneously, a fault sometimes
observed about the base line of the neck anteriorly and laterally where
the operator has been timid in avoiding the exterior and anterior
jugular veins. Such injections invariably result in abscess, or when
not extensive enough to cause necrosis the skin assumes a more or less
permanent red or yellow discoloration over the site so injected.
The treatment for the partial or total removal of such spots has been
referred to.
In the average case of contour restoration of the shoulders about eight
sittings are required, two sittings being given each week, and as many
injections made as is deemed necessary or advisable at each.
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