Plastic and cosmetic surgery

by Frederick Strange Kolle

While a fairly large defect can be corrected at one sitting, it is advisable to rather reinject one or two weeks later to secure the exact shape.

It is to be impressed upon the operator that there is always a slight broadening of this part of the nose following the development of the connective tissue which takes the place of the injected mass, hence the injection should not be overcrowded nor the parts overcorrected.

The mass should be molded out as narrow as possible and be pinched between the fingers by the patient two or three times a day after the reaction has subsided, which is usually about the third day. This procedure will keep the mass from being flattened during the time tissue replacement takes place.

Middle Third Deficiency.—This defect is commonly seen in football players and pugilists as the result of a breaking of the inferior extremities of the nasal bones and the displacement of the articulating cartilages, although the defect is often seen as a result of an injury to the nose early in life, causing a lack of development in the superior or articulating extremities of the cartilages. Nondevelopment from catarrh, syphilis, and intranasal disease are other causes. This type of deformity is generally designated as the saddle nose.

In the latter cases the skin is usually bound down to the cartilaginous structure by cicatricial bands, and needs to be liberated. This is accomplished subcutaneously with a fine tenotome introduced laterally.

To assure the operator of a thorough dissection he may inject the site with sterile water through the opening made with the knife, squeezing it out before injecting the nose.

If the skin has had to be freed by surgical means the mass injected should be sufficient to overcome the defect almost entirely, to prevent the reformation of the bands of connective tissue which have been severed. Their re-establishment would mean an unequal development of the new connective tissue springing up from the injected mass, thus defeating the object of the operation.

If no dissection has been done the defect should be corrected about two thirds and added to by a subsequent injection.

The mass in either case should be well molded out, especially at both sides, to keep the nose as narrow as possible. There will be more or less widening ultimately following the organization of the mass.