The success of an operation depends, first, upon the selection of the case; second, the selection of the method employed, and, third, upon the hygiene under which the patient undergoes convalescence. The patient must be given to understand, in many cases, that it is often necessary to reoperate, even to the extent of seven or eight operations, to bring about the desired result. The first result obtained with many cosmetic operations is not at all gratifying to the patient, and unless this is explained to him beforehand he may become discouraged awaiting the next operation and disappear, thus losing the opportunity of being pleased finally, while the surgeon is misunderstood and underestimated by narrow-minded judges and the ever-willing friendly advisers and critics—a consummation much to be avoided.
Preparation of the Operative Field
The part to be operated upon should first be closely shaven. The oily secretions of the area are next rubbed off with an absorbent cotton sponge saturated with alcohol or ether. Next, the skin is washed with hot water and soap or three-per-cent synol suds, then rinsed, and finally rendered aseptic with a bichlorid solution.
If the operation is to be done about the face a rubber cap is so adjusted as to cover the hair. If this is not obtainable sterilized bandages can be employed.
In operations about mucous membranes, as in the nose and mouth, the parts must be cleaned at short intervals with a solution of permanganate of potash or boric acid. The teeth must be cleansed with antiseptic soap, tartar is scraped off, and the mouth rinsed with a proper disinfectant. The corrosive sublimate, or carbolated solutions, owing to their toxic qualities, cannot be used. The preparation of wounds for reoperation, or where an operation is secondary to injury, is referred to later.
All clothing about the site of operation should be removed and rubber cloth placed to surround the field and cover the clothing. This should be covered again with sterilized towels. Everything that touches the patient after this has been done should be aseptic; indeed, hands employed during operation must be immersed from time to time in 1-500 bichlorid solution, and allowed to remain wet.