The History of Rhinoplasty ⑨-2 — Taking it out is harder than putting it in

In part five I told the story of the paraffin injections in Europe a hundred years ago.

Melted paraffin was put under the skin to fill a sunken bridge; it formed lumps in the tissue and caused inflammation, and the method was abandoned in the end.

It sounds like an old story from a far-off country, but something similar went on in Korea for a long time.

People were injected with substances of unknown identity in places that were not medical institutions, and came to a hospital a decade or more later to have them taken out.

I took on a number of those operations as the operating surgeon when I was at a university hospital. There is something I learned then.

Putting it in takes a few minutes. Taking it out takes an enormous amount of time. And even then, things do not go back to the way they were.

A substance injected as a liquid or a semi-liquid seeps between the tissue planes, so it does not stay as a lump with a clear boundary.

You reach a state where the eye cannot tell where the foreign material ends and your own tissue begins.

So an operation like this asks you to judge two things at the same time.

How much to take out, and where to stop. If you try to remove every last trace and lose healthy tissue with it, that place cannot be filled again.

This is also why requests for foreign-body removal are a steady part of our practice.

The commonest case these days is thread that has been put into the nose.

People who had the procedure done as a way of raising the bridge without an incision come in later because it can be felt, or shows through, or has become inflamed.

Thread removal works on the same principle. As thread settles inside the nasal tissue it builds fibrous tissue around itself.

So it does not come out by simply pulling it back the way it went in.

Which layer the thread sits in, in which direction, how many years have passed, what type it is — all of that changes the approach entirely.

To be honest with you, this operation takes longer and is harder than building a new nose.

Because you begin from a state somebody else created. What material went in and how is often something you only learn once you open it.

So this is what I say often in consultations.

Do only what can be undone.

In the hundred-year history of rhinoplasty, the methods that exacted the highest price were always the ones that promised a simple fix.

Paraffin was one. Industrial silicone was one. And so were any number of injected substances whose names nobody knows — all of them have made patients suffer.

The ease of the moment it goes in and the difficulty of the moment it comes out have always been inversely proportional.

I look at the new methods appearing now by the same standard.

If there is a problem later, can this be taken out? And if it is taken out, does the nose come back?

A method that cannot answer those two questions is one I do not recommend.