Von Esmarch has said that twenty operations about the nose are none too many if the desired result can be obtained. Dieffenbach has said that it is more difficult to restore smaller nasal defects than those of greater extent.
The latter applies particularly to cosmetic operations in which the surgeon is compelled to work through small openings or incisions always with the view of leaving little if any scar, and to place such scar where it may be least observed.
The best cosmetic surgeon is he who can accomplish results with the least secondary disfigurement.
PROTHESES
When for any cause there is a loss of the entire nose, and the patient is unwilling to undergo surgical operation for its restoration, the surgeon may resort to the use of protheses or artificial noses.
Such noses are made of papier-maché, rubber, wood, or light metal, and painted to imitate the color of the skin of the individual. They should be made after a model previously prepared by molding the new organ upon the face of the patient or after such patterns as the surgeons may have to choose from, fitting the skin juncture accurately in such cases.
If the surgeon lacks such artistic ability, a sculptor should be employed to model the proper organ suitable for and on the face of the patient, from which a plaster cast or mold may be made from which the maker of protheses can work.
With the model in hand and no expert on protheses within reach, a skillful surgeon-dentist could easily make a vulcanized rubber nose, which may then be painted to suit.
Some method of attachment must be provided for, such as one or two soft rubber plugs or stems to fit into the nasal orifice or permanent fixture to the bridge of a pair of spectacles. Gums or pastes as advised with aural protheses may be of service.
Celluloid protheses should never be used because of their inflammable nature; furthermore, they are easily damaged or cracked. Wax noses are of little use, although resembling the normal very closely; they crack easily, and when soiled by dust or friction soon have to be replaced with new ones.