Plastic and cosmetic surgery

by Frederick Strange Kolle

The author advocates the employment of a hypodermic needle attached to the syringe in place of the regular needle and that the injection be of sterile white vaselin without additions of any kind.

Such injections may be made very readily, one or more at the first sitting, being introduced below the deepest part of the defect. It is surprising how much four or five drops of such an injection will accomplish. Furthermore, it is to be remembered that the injections about the side of the nose are readily replaced by new connective tissue, equal to, if not commonly greater in amount, than the mass injected, such growth being completed in about two months after the time of injection. This may be explained by a more or less active perichondritis when the injection is made over the cartilage, the inflammation, thus set up, being of longer duration than where the skin and bone or areolar tissue are involved. Any subsequent injection should not be undertaken until at the end of two weeks or more for the reasons above stated.

The injected mass at all times should be introduced under normal pressure, never to the extent of rendering the skin above it white in color. The mass should also be molded out with the tip of the finger or the rounded, dull handle end of a scalpel. If necessary, the small finger may be introduced into the nostril to facilitate this molding. Should the reactive inflammation be severe such remedial agents as have been referred to should be used to reduce it.

Phlebitis following injections at the side of the nose is due entirely to the injection of a blood vessel and must be avoided. When a fine needle is used there is less likelihood of free bleeding from an injured vessel, therefore a thorough knowledge of the usual position of the vessels about the sides of the nose is absolutely essential. Bleeding of greater extent than that which would follow the thrust of the needle through the skin should put the surgeon on his guard. Experience is the better teacher and conservatism in these ofttimes delicate, subcutaneous operations will save the surgeon much annoyance and eventually the need of having the patient submit to a cutting operation to reduce an overcorrected area.

Should a hyperplasia of connective tissue result from such an operation, a small linear incision, under four per cent eucain anesthesia, should be made directly over the greatest prominence, through which the offending mass can be removed by the aid of a small hooked knife or a fine pair of curved scissors.

The mass should be removed beyond the plane of the skin; in fact, it should be rather removed in conelike form, apex inward, and the peripheral attachment completely obliterated, in order to obtain the desired result, as it is not unusual to have the prominence reappear after imperfect extirpation and improper dissection.

Moist pressure dressings may be applied over the small wound thus made, for several days, or until the inflammation following the operation has subsided. Suturing such a wound is hardly necessary, but if the incision be over one fourth of an inch long, two fine silk sutures, deeply placed, may be utilized, their tension adding to the compression needed to bring the mobilized skin into position in reference to the base of the wound.

The author has used contractile collodion in place of compress dressings with very good result. This should be renewed within forty-eight hours.

After eight or ten days silk isinglass adhesive plaster is applied over the wound until it falls off.