Plastic and cosmetic surgery

by Frederick Strange Kolle

Wenzel, after an unsuccessful attempt to overcome a laparocele by the injection of paraffin, a year later performed a radical operation of the parts. The excised tissue at the site of the injection showed deposits of the broken-up mass of paraffin, each being enveloped by a capsule of connective tissue without any signs of ramifying bands, and hence decided against the belief of the resultant tissue formation.

Eschweiler, the latest authority on the above question, after examining microscopically a portion of paraffin-injected tissue that had been carried “in situ” on the bridge of the nose for about one year, concurs absolutely with the connective-tissue replacement belief.

From the foregoing it may be definitely accepted that while there may be an encapsulation or encystment of the injected mass, be it what it may so long as it belongs to the paraffin group, there is always a ramification of the mass by the formation of the strands of new connective tissue which eventually in a month or more, according to the amount of the mass, develops to a size corresponding to the latter or even beyond the size of the latter, as will be mentioned later, and that in all cases the paraffin is ultimately and almost, if not completely, crowded out of the area occupied by the injection, and that its disappearance is accountable to absorption.

This absorption, following such an injection, is productive of no harm to the human economy, and the new tissue caused to be formed by such injection truly enhances the cosmetic and surgical value of the method inasmuch as an encapsulated mass of paraffin is liable to displacement, spreading, and irregularities, should it be subjected at any time to external violence.

Such violence, again, would lead to the irritation and inflammation of such cyst wall, causing an undue crowding upon the parts injected and possible gangrene of that part of the wall upon which such pressure was brought to bear, leading to unsightly attachment and ultimate contraction of the skin where bound down by the inflammation, or even evacuation by the absorption of gangrenous material and resultant abscess.

That this absorption or disintegration of paraffin is of no consequence may be proven by all the early cases in which such injections were used. Gersuny’s first case, having been done May, 1899, shows no diminution of the prothetic site at the end of two years. The same may be said of the hundreds of cases done by other operators.

The greater question in the mind of the author is what will be the ultimate behavior of this new connective tissue.

That the development of this new connective tissue is gradual has been mentioned, some authors claiming a complete replacement of the mass at the end of a month, others from two or three months. Morton says that four months’ time is required before the mass is, more or less, completely removed and replaced by organized tissue. The author believes, however, that the length of time necessary for this replacement not only varies, proportionately with the amount of paraffin injected, but that it differs in each case, and markedly with some patients in which the growth or developments of the new tissue did not cease for months and even a year after such injection. This corresponds truly to a hyperplasia, and will be considered later.

Time alone will show the ultimate behavior of this new tissue, and while it is reasonable to argue that this newly organized tissue could cause no untoward results, it must be determined whether this tissue will not undergo atrophy and contract, or become susceptible to other changes in time. It is a new tissue practically, and as yet we know nothing of its idiosyncrasies, although its histological nature is determined.

We do not know that irritations, such as surgical interference, will cause it to take on new growth, as evidenced by the attempts of extirpation of unaccountable overcorrections obtained with injections made early in the time of the employment of the Gersuny method, in which the parts practically grew back to their former size or became even larger. This may be accounted for by the fact that most, if not all, of the connective tissue was not removed or points to an active nucleus or several such centers which were not destroyed.