Plastic and cosmetic surgery

by Frederick Strange Kolle

The above solution makes up a single injection, which is to be made directly under the scar or into the muscular tissue below it. Two injections are given each week.

The treatment is to be continued until the texture of the cicatrix is equal to that of the skin.

These injections are more or less painful and may be supplanted to advantage with the hypodermic use of fibrolysin (Mendel), in which each 2.3 c.c. correspond to three grains of thiosinamin.

For very small scars, as those occasioned by blepharoplastic operation, the author employs the twenty-per-cent thiosinamin plaster mull made by Unna. These are to be applied every day or night, according to the convenience of the patient, and allowed to remain on for several hours each day.

At first these plaster mulls are inclined to cause erythema and exfoliation of the epithelium, therefore they might be used on alternate days to keep the parts more sightly.

For scars of large extent the above method will answer best. If there is considerable contraction, the parts should be massaged daily to soften and stretch them. Eventually the depression of contour may be corrected by hydrocarbon protheses introduced subcutaneously following subcutaneous dissection, if deemed necessary.

Small pits, where discrete, are best removed with a fine knife and brought together by a fine suture which is to be removed on the fifth day.

Confluent pittings, as after variola, must be removed by decortication or peeling methods.

The pits, if spread about the face promiscuously, may be treated separately by the peeling method, but when they lie less than one inch apart, it is best to treat the skin of the whole face.

This is done by applying pure liquid carbolic acid to the skin with a cotton swab. The skin at once assumes a white color. If the pittings are not very deep, one application of the acid is sufficient. If deep, one or two more applications are made as the preceding one dries. In very deep pits, the surgeon should apply the acid to the pit proper several times, blending off the application at the periphery.