Plastic and cosmetic surgery

by Frederick Strange Kolle

Nasolabial Furrows (Unilateral and Bilateral).—This condition in the bilateral form is exceedingly common in adults beyond middle age. It is also found in those individuals suffering from inanition, due to whatever cause. The unilateral form is found principally in patients suffering from semifacial paralysis in which the tissue lacking the proper neurotic supply droops or sags down, causing a deep furrow to appear from the attachment of the alæ to the angle of the mouth, associated more or less by a flattening of the cheek contour of that side of the face.

The method of correction advocated by the author varies entirely from the technic advanced by other surgeons.

The usual method has been to introduce the needle of the syringe at the outer or lower extremity of the furrow and from one of such punctures to inject the whole line of depression.

While this seems right theoretically the method does not give the desired result. Owing to the free movement of the upper lip the mass, at first neatly restoring the contour, is crowded upward into the inferior malar region and very often downward toward the angle of the mouth, where it settles in a hard lump which is not only obnoxious to the sight but interferes with the proper use of the parts concerned in mastication and vocalization. Invariably the operator is called upon to remove the disfigurement.

It can be readily understood that hard paraffin itself, in such case, would prove more objectionable than a softer mass which, upon early discovery, could be molded or massaged into better position, while nothing less than excision would prove efficacious with paraffin.

As with the lip, then, the author advocates the use of either the cold mixture of paraffin, as heretofore described, or the cold white vaselin according to the operator’s opinion in overcoming the extent of the fault. For all ordinary cases white vaselin alone is necessary.

The technic of injection as used by the author is as follows: In the ordinary case when the furrow is not too pronounced one sitting only is required. Two needle punctures are made above the upper line of the defect, the first being made about one half inch from the wing of the nose and the other about one inch outward and downward.

The needle is pushed downward under the skin until its opening corresponds to the median line or deepest part of the furrow. Enough cold white vaselin is injected to bring the depressed area slightly above the plane of the skin of the upper lip. The second puncture is made perpendicular to the first and the injection made in the same manner.

With the tip of the indicis over the first needle opening the mass is molded out evenly by a gentle rocking or rubbing movement. The same is done with the second mass.