Plastic and cosmetic surgery

by Frederick Strange Kolle

For this reason it will be found of some benefit to apply an anterior nasal splint of aluminium, covered interiorly with a fold of white flannel or gauze and pressed into such shape that when applied to the nose it will keep the latter pinched up laterally to the desired width. This splint will hardly ever be borne by a patient and causes great discomfort until after the post-operative reaction has subsided. It may then be bandaged or held in place by strips of Z. O. Adhesive plaster for an hour or two in the day and during the entire night.

After the first few days’ wearing the patient soon becomes accustomed to the splint. It should be worn as mentioned for about three weeks, when the patient may be permitted to pinch the nose laterally with his fingers two or three times a week or more.

The secondary injection may be made in the ordinary way or as advocated by the author in the manner described in correcting defects of the inferior third of the nose.

Inferior Half Deficiency.—In this type of deformity the greater point of nondevelopment or deficiency is found at the upper extremity of the cartilage of the septum, below its articulation with the inferior border of the nasal bones, and involving to a greater extent the area over the upper lateral cartilages.

This deformity, due to whatever cause, rarely affects the base or inferior part of the nose, owing undoubtedly to the greater protection and stability offered by the lower lateral and sesamoid cartilages and the dense cellular tissue making up the alæ. Except in such cases where violence of an extreme nature has been exerted in early life, or where ulcerative disease has broken down most of the cartilage of the septum, the point of the nose is usually normal in size and shape. In the latter cases there is an upper tilt of the lobule and a shortening of the columna upon itself with a convexity in an upward direction.

The cause of this type of deformity is usually a direct blow upon the point of the nose, syphilitic ulceration internally, catarrh, or other ulcerative disease.

When due to violence the point of the nose may or may not present a normal appearance, there may be a normal base tilted upward (retroussé or snout nose) or a dropping forward and downward (hook or beak nose).

The shape of the nasal base depends much upon the time of life the injury was received—that is, before or long after puberty, also upon the extent of injury inflicted and where applied.

From injuries received early in life we may look to a lack of development in the cartilage of the septum alone, or associated with deficiency in one or both lateral cartilages.

The deformity is usually symmetrical, but where the nasal bones have been injured as well, particularly where one bone is injured more than its fellow, there is a possibility of the disfigurement being unilateral. This is rarely the case except when due to punctured wounds; generally in such cases the anterior nasal line assumes a twisted form.