Plastic and cosmetic surgery

by Frederick Strange Kolle

This method, per se, is not in itself sufficient to bring about a satisfactory result. The fundamental principle is that of the sliding flap of Celsus, and in which the two flaps intended to form the new nose are taken from the tissue of the cheek at either side of the remains of the old nose.

The total outcome is simply to bring before the opening a curtain of skin with a median scar running from the root to the lobule, which in itself is sufficient upon contraction to mar the result; furthermore, there are the two lateral wounds which have to be covered by skin grafts which, upon healing, have their tension of contraction, added to that of the median scar, with the result that the anterior nose becomes flattened and ugly, practically amounting only to an unevenly contracted curtain of marred skin.

The author would not advise resorting to such method, but, owing to the fact that a step in the advancement of the art was conceived under this particular method, space is given to the subject. This step, first introduced by Nélaton, consisted of allowing all of the cicatricial tissue of the old nose to remain with which the new nose could be built. As the possibility of this is rare in total rhinoplastic cases, the method is more useful in partial rhinoplastics, where it forms an important factor, as will be shown later under that subdivision.

Nélaton Method.—Two lateral flaps of triangular form, having their pedicles below the internal canthi, are cut from the cheeks, each flap containing all of the remains of the old nose. The entire inner borders of these flaps were freshened throughout their whole thickness.

In making the flaps, dissection is made down and through the periosteum, thus giving firmness and thickness to the new nose. The flaps are slid forward and sutured along the median line, leaving a triangular wound of the cheek on either side, as shown in [Fig. 339].

To keep the raw surfaces in contact with the newly dissected area and to retain the nose in place as far as possible, a silver pin is inserted through the base of the new nose, going through the skin and remains of the old nose. It should be of sufficient length to permit holding a disk of cork at either end, beyond the skin and for the retention of the metal ring ends of a hook bent in inverted U-shape. The diameter of the latter bent wire is equal to that of the pin.

He claims for his method a perfect and fixed cicatrization of the newly placed parts.

Fig. 339.—Nélaton Method.