Plastic and cosmetic surgery

by Frederick Strange Kolle

Here, as with lateral nasal injections, there seems to be an overproduction of new connective tissue following such an injection; a decided factor in eventually pleasing the patient.

It is needless to say that the operator must avoid injecting one of the blood vessels of the lobule, as this will cause considerable inflammation from which the lobule does not recover readily, owing to the dense tissue the surgeon has to deal with, leaving the tip of the nose discolored and bluish for some time after the operation.

If the injected mass causes an immediate venous stasis of the lobule, hot applications should be applied at once, or as soon as the operator discovers that the proper massage and pressure to remove the offending mass does not improve the circulation.

The author advocates the judicious use of antiphlogistin, faithfully applied hot every six hours and continued until the acute inflammatory symptoms subside, when the surgeon may resort to ice cloths or cold pack until the danger of pressure and resultant gangrene have subsided.

Despite the very grave symptoms associated with such inflammation, the operator may assure the patient against permanent disfigurement, although the three or four weeks’ duration of treatment, usually required in such cases, is an ordeal the cosmetic surgeon and the patient are not liable to forget.

If the injected mass causing this state of affairs has been of liquid paraffin, the better method to pursue is to make several small incisions into the site of the injections and remove the little masses of solid paraffin as far as possible with the view of relieving the pressure or encroachment, at the same time alleviating the pain and stasis by the resultant depletion. Moist, hot applications should follow this procedure. The small wounds made in the skin will heal without suture, leaving hardly any perceptible scar.

The author, however, advises against any mixture or liquid paraffin injections about the lobule, never having seen a satisfactory result when either had been employed.

The post-operative treatment in uncomplicated cases may be of aristol and adhesive isinglass plaster or collodion.

Interlobular Deficiency.—This condition is hereditary in the great majority of cases. The defect, while quite disfiguring, giving the appearance of a cleft nasal point, is easily corrected by the subcutaneous injection method.

Paraffins of high melting points should, however, never be employed for this purpose for diverse reasons: first, the hardening of the mass after cooling causes too much pressure upon the small blood vessels at the point of the nose and results in more or less permanent discoloration of the tip; second, by reason of the pressure of a hard mass, at the end of the nose, considerable inflammation results which usually terminates in the evacuation of the entire mass and consequent cicatrization; third, by virtue of the greater irritating qualities of paraffin a greater amount of new connective tissue than necessary is thrown out, causing a general and hyperplastic rounding of the entire tip of the nose that requires surgical interference to overcome. In the illustration shown the patient’s nose was injected along the entire anterior line and the lobule with paraffin liquefied under heat. A marked post-operative inflammation resulted, with permanent redness of the entire organ and several decisive capillaries showing about the sides and tip of the nose. This was followed in about six weeks by a progressive hyperplasia which left the nose about three times its natural size, and the lobule a hard, ball-like knob of high red color. Several cosmetic operations were required to make the nose appear anywhere near normal, while the electrolytic needling process was resorted to for a number of sittings to destroy the acute redness and the individual vessels showing.