Plastic and cosmetic surgery

by Frederick Strange Kolle

Later Neumann Method.

Bardenheuer Method.—This author makes a transverse incision across the root of the nose, and two lateral incisions from either end of the first, carrying them downward and outward, as shown in [Fig. 401]. These incisions are made down to the bone. With a chisel the nasal bones are separated from their frontal and superior maxillary attachments, giving an arch of bone to the flap, which is brought downward and outward, the bone being dissected from the underlying mucosa. To facilitate the bringing down of this flap the anterior border of the cartilaginous septum must be divided if present.

The flap thus made is attached only at the two points of skin at the inferior borders, the epidermal surface looking inward. The archlike mass of bone is gently bent backward at either side to practically reverse its convexity. The position of the flap is shown in [Fig. 402].

The raw surface of the flap above mentioned is now covered with a flap taken from the forehead in the form shown in the figures.

The resultant nose is entirely lined with skin, and contains sufficient bone to support it. The objection is that there must necessarily be a large secondary wound in the forehead, which must be covered with Thiersch grafts.

Fig. 401.—Shape of flap.

Fig. 402.—Disposition of nasal flap.

Bardenheuer Method.

Ollier Method.—This author uses an inverted V incision, beginning on the forehead at a point about three centimeters above the superior margin of the eyebrows. The diverging incisions are carried down to a point just above the base of what remains of the old nose, where it remains attached.