In considering plastic operations about the face (Curta in auribus, labrisque ac naribus) he writes, “Ratio curationis ejus modi est; id quod curtatum est, in quadratum redigere; ab interoribus ejus angulis lineas transversas incidere, quæ citeriorem partem ab ulteriore ex toto diducant; deinda ea quæ resolvimus, in unum adducere. Si non satis junguntur, ultra lineas, quas ante fecimus, alias dua lunatas et ad plagam conversas immittere, quibus summa tantum cutis diducatur, sic enim fit, ut facilius quod adducitur, segui possit, quod non vi cogendum est, sed ita adducendum ut ex facili subsequatur; et dimissum non multum recedat.”
Centuries elapsed before a clear understanding of the above was deduced. Several analyses have been advanced, those of O. Weber and Malgaigne being the most generally accepted.
As shown in [Fig. 1] the method advanced is one for the restoration or repair of an irregular defect about the face in which two transverse incisions forming angular skin flaps, dissected from the underlying tissue, are advanced, joining the denuded free ends.
Should there be a lack of tissue to accomplish perfect coaptation a semilunar incision beyond either outer border is added, as shown in [Fig. 2], which permits of greater traction, leaving two small quatrespheral areas to heal over by granulation:
Fig. 1.—Celsus Incision for Restoration of Defect.
Fig. 2.—Celsus Incision to Relieve Tension.
This is the oldest known reference to plastic surgery of times remote.
From the Orient, however, Susrata in his Ayur-Veda, the exact period of which is unknown, discloses the use of rhinoplastic methods.