In traumatic cases the scar attachments should be freely liberated, under eucain anesthesia, by the aid of a fine probe-pointed tenotome, before the cold paraffin mixture is introduced.
In such event only one opening should be made and just enough of the mixture be injected to raise the skin to its normal contour, if this be possible. Generally, later injections are required, and these may be made without further dissection. They should not be undertaken until the incised wound made with the tenotome has healed thoroughly, otherwise the pressure of the injection is liable to burst through the delicately healed wound, and thus delay if not endanger the success of the first operation.
When the reaction following such injections be severe, associated with considerable edema, cold pack or ice cloths should be applied or resort may be had to hot applications of antiphlogistin. The patient should be kept on his feet during the day and sleep with the head high at night. The bowels should be kept open, and general tonics be given if indicated. The patient usually returns to the normal, except for a little tenderness about the forehead, in three or four days under the treatment outlined.
Deficient or Receding Forehead
In this condition there is usually a transverse lack of contour across the forehead above the superciliary ridges, giving the patient a degenerate appearance. The defect is congenital and is to be corrected, as described in the foregoing division, although the injections may be at either outer or temporal end of the forehead, gradually being brought nearer to the median line until the contour of the whole forehead has been raised by subsequent injections.
Unilateral Deficiency
This defect may be traumatic—the result of direct violence, but is more commonly due to a frontal sinus operation.
In both events it will be found necessary to detach the cicatrices that bind the skin down to the injured bone, before a prothetic injection may be undertaken.
In some cases where the cause of the deformity has been moderate and the scar is linear and of long standing the injection may be undertaken without subcutaneous dissection.
Several injections are necessary, as the tissue about such parts is usually much thickened, apart from the firmness added by the scar tissue.