The injections in such cases should be made at least three days apart, two being made at each sitting, after the central or two inner depressions have been raised by the first operations. These later injections should be made to relieve the furrows lying next to the median, gradually working out to each slant side of the cone until the contour of the middle forehead has been made normal.
Never superimpose an injection about the median line until the major defect in general has been overcome, and only then when the first injections have become settled and organized, as such untimely disturbance is liable to set up considerable reaction, with enough induration and resultant new connective-tissue formation to cause a decided lumpy or protuberant appearance of the part.
The mixtures of low melting points should be preferred to the harder variety in frown corrections. They lend themselves to better molding, and seem to undergo organization with less pathological change than those of the latter class.
When the injections must be made over the inner third or half of the eyebrows, as is often the case, they should be made well above the hair line and molded out in an upward direction, to avoid the dropping down of the mass into the upper lids or to prevent the resultant displacing connective tissue from involving them.
If the upper lids do become involved, as shown by fullness, hardness, and partial ptosis, the connective tissue causing the same must be carefully cut out from the lid by a transverse semicircular incision made in the upper lid along the line of its backward fold or hinge. If need be, an elliptical strip of the skin of the lid may be removed at the same time to give better scope to the extirpation under consideration.
The author has recently corrected two such cases where a surgeon had hyperinjected the entire forehead with a combination of oils at one or two sittings. The resultant involvement and later discoloration of the lids at the end of a year’s time might have been expected.
Such wounds, when neatly sutured with No. 1 twisted silk, leave surprisingly little scars; in fact, the cicatrices are rarely ever detected a few days after healing has been established.
The treatment post-injectio for all furrow protheses should be as already laid down.
Apart from general surgical cleanliness and an antiseptic powder, the blepharoplastic operation mentioned required no special attention. The sutures may be removed in forty-eight hours.