Plastic and cosmetic surgery

by Frederick Strange Kolle

If a liquid paraffin or hydrocarbon mixture or vaselin is used, the immediate use of ice cloths applied to the part as digital pressure is removed, is advisable to aid in the rapid hardening or setting of the injected mass before the tension of the tissues over and about it might influence it. With semisolid injection this is not necessary, except in the subsequent treatment, as will be considered later, because the mass, unless of too soft a consistency, as, for instance, vaselin, will practically remain as injected and molded.

Vaselin when injected into tissue where there is tension would naturally be forced out of position and shape, and should not be used except in combination with a paraffin of a melting power high enough to give the proper consistency to the former.

12. Interference with Muscular Action of the Wings of the Nose.—That nasal respiration may be encroached upon as a result of injecting paraffin about the nose has been observed by Alter. He points out that during nasal inspiration there is a tendency for the alæ to contract upon themselves or to move inward, decreasing the lumen of the orifice, and that in the normal state this movement is counteracted by the action of dilator muscles of the alæ—that is, the dilator naris anterioris, the pyramidalis nasi, and the levator labii superioris alæque nasi—and that this muscular action is interfered with owing to the pressure of the paraffin upon these delicate structures, and resulting in more or less permanent collapse or indrawing of the alæ during inspiration. He observed considerable interference with inspiration in a case cited in which an injection of paraffin had been made.

To avoid undue pressure upon the structures referred to, it is advised to have an assistant place a thumb into each nostril and the index fingers without and above the alæ in such way that the tips of the fingers may be enabled to exert the necessary pressure over the injected mass into these structures, and to maintain this pressure until the mass has been properly molded and set. Connell advises inserting the little fingers into the nostril to prevent an encroachment on the lumen of the nasal canal.

The above applies particularly to those cases where injections are made into the anterior lower or lateral third of the nose, as, for instance, in overcoming slight depressions in the anterior line, immediately above the lobule or in a low unilateral deviation of the nose.

13. Escape of Paraffin after Withdrawal of Needle.—When the injected mass employed is of a semisolid consistency, as heretofore advised, it is hardly possible for the mass to be forced out through the opening of the skin made by the introduction and withdrawal of the needle, unless there be an unwarrantable immobility of the skin above the site to be injected. The latter should be corrected before injection.

The mass after having been molded in the shape desired may be further hardened and set by the application of ice cloths or spraying with ether before the needle is withdrawn from the skin, yet this is hardly necessary, and the author advises against the practice for the reason that pressure of the needle prevents proper and free molding of the mass and renders the tissue liable to further injury by scraping its point to and fro subcutaneously, adding to the extent of the wound and the dangers of infection and repair.

The skin immediately around the needle hole, after withdrawal of the needle, may be gently smoothed out with the dull rounded metal handle end of the bistoury to free the interdermal canal of any foreign matter.