Plastic and cosmetic surgery

by Frederick Strange Kolle

The reaction in these cases is very little, rarely necessitating other than an antiseptic powder-plaster dressing. Subsequent injections should be made if the first do not give the desired contour; but never until the surgeon is satisfied that the resultant new connective tissue thrown out has reached its ultimate growth.

The harder paraffins, especially those injected in the liquefied state, are not to be tolerated for the reasons given with the preceding method of correction.

Subseptal Deficiency (Partial and Complete).—It is not uncommon to find a marked concavity of the subseptum in noses that have sunken in by reason of intranasal disease or traumatism.

This concavity, when partial, is usually most marked near the lobule, but in the complete variety the upward curve may be greatest near its juncture with the lip.

Owing to the usual adhesions formed during the inflammatory period causing the deformity the correction of this defect is quite difficult. As a rule, the skin of the entire subseptum needs to be dissected away from the underlying structure before it will permit of correction by the injection method.

This dissection is advocated and can be readily done from one of the nostrils at a point just beyond the union of skin and mucous membrane.

The dissection under such method can be made more thoroughly than when done exteriorly, for the reason that the entire field is laid open to a free use of the scalpel, leaving no visible cicatrix externally. The dissection may be followed by the immediate injection of the mixture of paraffin and vaselin, as already referred to, used cold, or the area is injected with normal salt solution until the intranasal wound has healed, which usually takes place in about five days. The mucous membrane in such instance may be neatly but not too tightly sutured with No. 1 silk. If the operator deems it advisable he may inject the salt solution again on the third day to prevent the formation of such adhesions as may interfere with the ultimate hydrocarbon injection. This is rarely found necessary.

If the post-operative inflammation prove mild, then the adhesions will not be as tenacious, in which case the surgeon may wait until even the seventh or eighth day before injecting the paraffin compound, to be sure of not forcing the intranasal wound apart under the pressure of the mass injected.

Never should so large a quantity of the mass be injected as to cause blanching of the narrow strip of skin. This is sure to result in gangrene of some, if not all, of the skin of the subseptum—a result much to be regretted, since subsequent correction of the deformity increased by the contraction of the dermal cicatrix is rendered well-nigh impossible by reason of this very tissue.

Hard paraffin injected in its molten state is never borne in this part of the human economy. It is usually thrown off after a few days of very painful and highly inflammatory symptoms, undoubtedly explained by the fact that the circulation of the subseptum is principally dependent upon the delicate branches of the two small septal arteries of the superior coronary and a hard, ungiving mass would readily cause their obliteration.