The author advocates making two such injections, at the same sitting, when the deformity has persisted. These injections are made parallel to each other with a distance of about one eighth inch between them.
The subseptal deficiency will also have to be corrected. This will be referred to later under its separate division.
The reaction in cases of this type is usually more severe than those just mentioned. There may be considerable swelling and discoloration, but by following the methods of treatment laid down heretofore the symptoms usually subside in two or three days.
Superior Half Deficiency.—In this type of deformity there is found a nondevelopment of the bridge of the nose, while the greater part of the cartilage of the septum and the lower lateral cartilages seem to be quite normal in contour. The nose has a dished appearance, with an undue prominence of the nasal base or lower half.
Various causes may be given to this condition, but heredity is responsible in a great majority of the cases.
The deformity in the type under consideration rarely takes in an accurate half of the nose, there being an involvement more or less of the lower anterior half, yet it is sufficiently distinctive to give it specific classification.
For the correction of the defect in such cases the injection is made laterally, the same mass being employed as in the preceding cases.
In this type of case the mass injected should quite correct the defect and be molded with great care to a desired contour, keeping in mind always the condition and elasticity of the skin overlying it.
An inflexible skin should be rendered mobile by digital massage, practiced for a few days prior to operation, or in tense conditions be loosened by subcutaneous dissection.
The great fault in injecting so large a quantity as is necessary in these cases is to make the nose too wide from the very beginning, which, added to the widening following the replacement by new tissue, makes the shape of the nose unsatisfactory.