IV. Dissection and turning down the triangular flap of skin which surmounts the orifices of the old nose, and making it serve to line the lower part of the frontal flap.
V. Suturing the frontal flap thus modeled into two grooves made into the margins of the old nose along both sides to its base.
Organic Support of Nasal Flaps
It soon became evident to the rhinoplastic surgeon that without some support to the flap or flaps used for the construction of the new nose all of the preceding methods, as far as æsthetic results were concerned, were useless. Truly, the deformity lost its hideous appearance to a great extent, but the general results obtained hardly warranted a patient to undergo restorative operations of the nose. In fact, many surgeons advised against total rhinoplasty when practically all of the old nose was lost.
Langenbeck says “that total rhinoplasty, or even operation as to repair partial loss of the nose by the use of soft flaps, should not be undertaken. It is better to rely upon some prothesis.”
All that could be expected of utilizing the flap and making it heal into place had been accomplished up to about the year 1879. Thereafter many surgeons proceeded to evolve and use some kind of intranasal prothesis made of various inorganic materials. It may be stated, however, that Rousset in 1828 wrote: “Perhaps some day surgeons will give whatever shape they desire to the reconstructed nose. Then a frame of gold or silver, cleverly shaped and solidly fixed in the nose, will give the patient, at his own option, a Roman or Carthaginian nose, and to the ladies a choice of a roguish type, and to our Sultans a nose a la Roxelane.”
But it was after 1878 that such prothesis came into use, and these were at first made so that they might be removed at night and be replaced in the morning.
The intranasal supports were made of all kinds of material, such as gutta percha, gold plates, leaden devices, amber, silver, porcelain, celluloid, aluminum, platinum, etc.
With all due respect to the ingenuity of these inventions, especially that of Martin, which was made of platinum in the form of a St. Andrew’s cross, having at the four ends sharp pins which were driven and fixed into the skeleton of the nose, the use of these protheses resulted in nothing but failure.