The Washington times., 1919-02-23
Types of Noses, Viewed from
Underneath.


ber an article printed recently ex-
planning an operation on Madame
Yorska, the welIknown French actress, to
correct the very unsightly lines Of her
nose. This article has aroused a cOnsid-
cradle interest and many letters have been
received asking for more details of this
operation.
Further investigation seems to make 1t
clear that facial surgery is not at all un-
common for the purpose of correcting ugly
features. Not every surgeon, of course,
gives attention to this speciality. There
are, however, a number of surgeons who
make this a part of their regular practice.
On this page are photographs of an op-
Grafton for correcting an unsightly hump
on the nose Of an otherwise very attract
i've girl. The entire operation was per-
formed with local anaesthetic without the
use of ether or chlOroform. The patient
was thoroughly awake and aware of what
was going on, but did not feel the instru-
ments. In this particular case the opera
ton was performed entirely without leav-
ing any scar, because the surgeon worked
from inside the nostrils.
In describing this operation and his gen.
eral methods the operating surgeon ex-
planned that the first step was to prepare,
the patient as in ordinary surgery Per
feet cleanliness and asepsis Of the site to
be operated on and adjacent surfaces are
established. The nose is repeatedly
washed out with antiseptics The face is
scrubbed with strong soap. Clean aseptic
cloths are placed over the hair and body
to prevent dirt being carried from them.
Local anaesthesia is produced with CO.
Caine. The surgeon paints the mucous
membrane lining of the nose with a ten
per cent solution Of cocaine. This he re-
peats once, and then follows it with an
application of a solution Of pure adrenalin,
which checks bleeding. After a few
minutes, he injects into the septum a one
per cent solution of cocaine, to which has
been added adrenaIin in the proportion of
one to ten thousand.
Those steps establish complete anaes-
thesia of the interior of the nose The
surgeon next injects the same solution into
the exterior part of the nose all the way
down 20 the tip. Through these measures
he is able to perform an absolutely pain
less and blOodless operation.
The patient remains in a sitting position
during the operation. which is further
guard against hemorrhage.
tNow comes the actual work of cutting
the unsightly hump from the bridge of the
nose The surgeon pushes his delicate,
keenly sharpened scaIpel or knife up the
nostril and makes an incisiOn in the
mucous membrane lining of the nose. be-
ginning at the lower edge of the nasal
bone and running downwards about an
inch. This procedure avoids making
scar on the outside of the nose and also
avoids destroying any mucous membrane.
The incision is repeated on each side
Of the nose An exquisitely polished in
strument for raising up small flaps of
tissue called an elevator is then passed
through the incision between the cheek
bone and the pe7iosteum Cbone covering).
The surgeon then detaches and lifts up
the soft tissues Of the nose and also a
5sart Of the cheek from the bone. so that
sc Will be possible TO move the soft tissues
IN any direction desired.
avsThis is a very important and delicate
5Sroceedfng requiring extreme skill. If the
Tissues are not detached properly the skin
iever the nose would wrinkle simply be
cause the elasticity of the skin is not suf-
5feient TO adapt itself TO 80 small an area,
but if all this tissue is sknfully detached
grom the hone, the skin will adapt itself
over the bone without any disfguring
Wrinkles.
After the surgeon has detached all of
the soft or movable tissue Of the nose from
ms. root down to its tip, he proceeds to
mould the feature into the desired shape
= He takes fine saw and always working
from within saws away the bony excres.
cence from the bridge of the nose. This