Plastic and cosmetic surgery

by Frederick Strange Kolle

Cold or hot applications, as may be best borne by the patient, can be used; they tend to reduce the puffing and lessen the ecchymosis. The patient should be instructed to lie with the head higher than usual for the first two nights to retard the edema.

Furrow about Canthus (Unilateral and Bilateral).—This condition is commonly called “Crow’s Feet,” and is, in the majority of cases, due to advancing age, but is acquired by habitually contracting the eyelids, as in laughing or grimacing. It is particularly noticeable in persons employed in the drama.

The defect is usually bilateral, but may exist at one side only in rare cases.

The correction is easily accomplished by this method of subcutaneous injection, although a reduction of the furrow alone does not suffice, leaving a lump or elevation at the site. The author shades off the injection, as it were, making the site somewhat conelike, the apex being at the canthus and the base outward toward the hair line of the temporal region.

Sterile oil should be injected near the canthus, where the overlying integument is delicate. One such injection, covering an area of the diameter of half to three fourths of an inch, should be made, and thus backed up or built outward with two or three injections of the white vaselin, as described under temporal muscular deficiency.

The hypodermic needle should be used near the canthus, and the regular one over or about the temple.

The reaction near the canthus is similar to that with lid injections. The same post-operative treatment as with the lids should be employed.

Deficiency of the Ocular Stump.—It frequently happens that by reason of extensive inflammatory disease and adjacent adhesions of the eye, a greater part of the globe must be excised than in the usual case, whether the operation be an ordinary excision, the Mules’s evisceration or the Frost modification of the latter.

In such event the granular button or the stump made of Tenon’s capsule is too small to permit of the placing and retention of the artificial eye. In other instances the stump is so contracted that while the artificial eye is retained it must of necessity be allowed to rest deep in the socket, destroying the entire contour of the orbit. Again in the enucleation operation so little of Tenon’s capsule engages the artificial eye that movement is entirely destroyed, particularly when the Mules’s glass globe has not been introduced.

Excellent results may be obtained in some of these cases, others are not amenable to the injection method because of a lack of sufficient stump to inject, and the danger of injecting through the posterior wall of the capsule, the mass in part escaping into the orbital apex, where it is liable to impinge sufficiently upon the remains of the optic nerve to cause sympathetic inflammation of the normal eye. A condition at once not easily corrected, proving dangerous to the sight of the healthy eye, and possibly producing a fatal termination.