Plastic and cosmetic surgery

by Frederick Strange Kolle

While a preparation injected cold can be more easily governed from without by digital pressure or guidance, what can be said for a hot seething preparation introduced under great pressure?

Furthermore, when paraffin is injected in liquid form, especially when so rendered by a temperature necessarily even higher than the actual melting point, there is danger of searing the entire site intended for injection—a condition inducive to no good and a burning of the skin where the necessary superheated needle enters it, causing a punctate scar, more or less painful during the time required to heal the wound.

With the later knowledge that small amounts should be injected, and that such injections should be repeated, it being known that such method facilitates the production of new connective tissue, may we not draw the conclusion that the result obtained by the injection depends not upon the injection per se, but the resultant of that injection—namely, tissue production, and that this tissue production is the outcome of a stimulus in the form of that injection?

There has not appeared an authority who has claimed otherwise for injections of paraffin hot or cold, while it is true that the use of liquefied paraffins at high temperatures have caused all sorts of untoward results, while those of lower melting points in similar form have not escaped objections.

The author has used the cold-injection method in over three hundred nose cases without a single case of sloughing, embolism, or death, and in no case was there secondary diffusion or hyperinjection. The only fault has been the desire on the part of the patient to be finished too quickly, which usually leads to a result not as satisfactory as when the injections are made sufficiently far enough apart to allow the formation of organized tissue at the site of injection.

Gersuny’s preparation of paraffin, particularly useful for the cold-injection method, is made as follows: A certain amount of cold paraffin, melting at about 120° F., and white cosmolin or vaselin, melting at about 100° F., are mixed by being heated to liquefaction. The bulb of a clinical thermometer is then coated with the cooled mixture of paraffin, which is then placed into a hot-water bath, the temperature of which is gradually raised until the paraffin melts and floats upon the surface of the water. The water is then allowed to cool and its temperature noted just as the oil-like liquid paraffin begins to look opaque, which marks the melting-temperature point of the mixture.

Should this be found to be too high more vaselin is added, or vice versa, until the desired quantity of both is known.

This method of preparation is, however, a tedious and awkward one, and can be readily improved upon by mixing certain known quantities of the one with the other after the first experiment.

The author recommends the following formula for the preparation of a mixed paraffin, which he has found serviceable and satisfactory for use with cold-process injections and employed by him for the last four years.