Scire facias

“ The bloodless and livid skin, ploughed and wrinkled with these raised cicatrices, was drawn tightly over the cheek-bone. The eyelid, strangely misshapen, was alone the natural colour of flesh, but this eyelid looked as if it were artificially attached to the underpart of the eyebrow, and on the forehead above the eye there was a white scar, as if the flesh had been cut away to form the eyelid. I dared not look at her, and yet, in spite of myself, my eyes kept seeking her face. A death's head would be a more agreeable companion at table. ”

“ That frightful scar running all the way down one side of his clean-shaven face, from his eye to his chin, must have been made with a knife; but no one knew how it had been done, and that made it all the more mysterious. ”

“ Wounds on the face, as elsewhere on the body, do not leave a scar unless they go right through the skin. Serious wounds of the face always leave scars, and the scars will be prominent in inverse ratio to the skill with which the original cut was treated. ”

“ The immense development of the face below the brow, its enormous width between the cheek-bones, the absolute and sickening plausibility of the whole expression, the great lower jaw, the cruel callous mouth (look at this mouth closely) , and the peculiarly uncanny light blue eyes, are a collection of danger-signals that are rarely seen in one face. But his victims were probably deceived by this wretch's fat, easy, and bland manner—they stifled their instinct, and were duly poisoned. ”

“ Where should be the nose, was seen only a blackened cavity—the cheek had sloughed off during life, and presented only a spongy and half decayed bone—around the eyes which were imperfectly closed, was a dark putrid line, while the throat was swollen, and what remained of the teeth of the lower jaw, were exposed to view, by the absence of the nether lip, which had perished as other portions of the face—yet reader, in that horrid visage she recognized her seducer. ”

“ As if more effectually to complete the unfavorable impression of such an outline, an ugly scar, partly across the cheek, and slightly impairing the integrity of the left nostril, gives to his whole look a sinister expression, calculated to defeat entirely any neutralizing or less objectionable feature. ”

“ The skin of his face was colorless, and had a bleached appearance, all the lines running down, as if it had been rained upon every day for a dozen years. High up, reaching nearly to the cheek-bones, the hairy investure began, and that seemed to have yielded also to the causes which made all the facial lines perpendicular. It was guiltless of curl, or curving line of beauty, but shot down, straight and thick, a dark brown mass, wiry and unsightly. The hair upon his head was long, dry, harsh, and straight, lying like the mane of some beast upon his shoulders. ”

“ It is the bursting of shrapnel that causes the face mutilations, and although the first room we visited at Chaptal was a witness to the marvelous restorative work the surgeons are able to accomplish—sometimes—many weeks and even months must elapse while the face is not only red and swollen, but twisted, the mouth almost parallel with the nose—and often there is no nose—a whole cheek missing, an eye gone, or both; sometimes the whole mouth and chin have been blown away ”

“ A cicatrix or scar consists of closely packed bundles of white fibres covered by epidermis; the skin glands and hair follicles are usually absent. The size, shape, and level of the cicatrix depend upon the conditions which preceded healing.
A healthy scar, when recently formed, has a smooth, glossy surface of a pinkish colour, which tends to become whiter as a result of obliteration of the blood vessels concerned in its formation. ”

“ In cases of severer form the cicatrix is removed by an elliptical incision, the lip returned to its natural position, and a pedunculated flap of skin is taken up from the chin or the cheek which is rotated into the wound, or a skin graft is implanted into the area by the Wölfler method and sutured to the free margins of the skin, or the Thiersch method may be employed. ”

“ Too long has the face been degraded from its rank as a thing of beauty to a mere vulgar index of character or emotion. We had come to troubling ourselves, not with its charm of colour and line, but with such questions as whether the lips were sensuous, the eyes full of sadness, the nose indicative of determination. I have no quarrel with physiognomy. For my own part, I believe in it. But it has tended to degrade the face æsthetically, in such wise as the study of cheirosophy has tended to degrade the hand. And the use of cosmetics, the masking of the face, will change this. ”

“ There are a thousand physical transgressions that dim the lustre of the eye, or sink it too deep in the socket, or flatten it, or paint a circle round it. So of the face in general. There are a thousand forms of transgression that take away the carnation of the lip and cheek, and leave unnatural hues, not to say pimples and furrows, in its stead. ”

“ So in this scar I was not going exactly to copy that riven throat, but, with slender rolls of cotton, covered and held by gold-beaters' skin, I was going to create dull white welts with angry red spaces painted between—with strong sticking-plaster attached to my eyelid, I was going to draw it from its natural position. Oh, I should have a rare scar! yet that poor woman might herself see it without suspecting she had given me the idea.
Oh, what a time of misery it was, the preparation of that play! Poor Mr. Daly—and poor, poor Miss Morris!
You see everything hung upon the mad-scene. ”

“ Just then the prostrate monster’s hideous head changed suddenly to a human visage almost as horrible—a brutal, ruffianly, soulless face, with a bristling red beard and a low, receding forehead, across which ran a broad smear of blood. ”

“ No. 43 shows a scar a little farther back, in the neighbourhood of the ora serrata; but in this case the wound appears to have healed solidly. The pigment of the underlying uveal tissue shows a marked disturbance, whilst before the specimen was cut it was observed that the sclera was pigmented in the neighbourhood of the cicatrix.
In No. 8 the wound lay in the limbus, and the solidifying scar can be traced right through the thickness of the ocular tunic and down to the mass of inflammatory exudate which surrounds the dislocated lens, and fills the angle of the anterior chamber. ”

“ And full across this crown, disappearing in the thicker fringe above the ears, ran the most prodigious scar I had ever seen. Because the vision of it was so fleeting, ere the match blew out, and because of the scar's very prodigiousness, I may possibly exaggerate, but I could have sworn that I could lay two fingers deep into the horrid cleft and that it was fully two fingers broad. There seemed no bone at all, just a great fissure, a deep valley covered with skin; and I was confident that the brain pulsed immediately under that skin. ”

“ The punishment, in India, of cutting off the nose and ears, is common, but they have a method of substituting a piece of their forehead for another nose: this operation is painful indeed! But to my subject: John Levesley, who had been taken in the same ship with myself, and who was a presumed doctor, undertook, for six rupees, to put a nose on a poor wretch’s face, who had lost his own fourteen years before. The ignorant man, believing in the abilities of this surgeon, consented to undergo the most painful operation, that he might accomplish the business. ”

“ But serious results sometimes follow letting nature alone in such a case, as the pus from an eyetooth may burrow its way into the internal parts of the upper jaw, or into the chambers of the nose, while that from a back tooth often breaks through the skin on the face, leaving an ugly scar, or, if in the lower jaw, the pus may find its way between the muscles of the neck, and not come to the surface till it escapes through the skin above the collar bone. ”

“ True, a surgeon cannot be expected to build an entire nose from the skin or other tissue of the forehead or cheeks and make it a thing of aforethought beauty and shape, but if the result be no more than a curtain of skin to hide the hideous deformity he has done his share, and such result is the worst he might look forward to. ”

“ Young as well as old take infinite pains to disfigure the person, and thus to render it ferocious in appearance. Scars obtained in brawls and conflicts from stones and cold steel are esteemed the highest ornaments, and the breast and stomach are usually seamed with a mystic maze of rhombs and reticulated triangles, produced by scarification with a sharp fragment of obsidian, so as to resemble the plan of a fortified town of days gone by.
The upper lip is denuded with the creese, and the scanty beard suffered to flourish in curls along the cheeks and over the chin ”

“ When the swelling is much raised up to a point, unconcocted, thin, and devoid of vitality, we must cut out a piece either like a triangle, or like a myrtle leaf, or of some other angular figure, because the circular is unfavorable to cicatrization. Those which are not pointed we open by a simple incision, and when we find a sinus, if the part is fleshy and the skin proper for uniting, we only make such incisions into the part as will allow the matter to be discharged; but if it be thin and very devoid of flesh we make a simple incision along its whole length ”

“ Autodermic Skin-grafting.—Larger pieces of skin may be excised from selected parts of the body, preferably the outer side of the arm, and utilized to cover the entire defect. The piece of skin is cut about one third larger than the size and shape of the area to be covered. This method was first introduced by R. Wolfe in 1876, and gives splendid results. He advises removing all subcutaneous adipose tissue from the graft by gently cutting it away with fine scissors or the razor, and then loosely suturing the flap to the skin surrounding the denuded defect. ”

“ With the above modification of the Larger method a considerable loss of substance can be restored, the new lip being constructed of normal tissue of the lip lined with mucous membrane retaining the saliva. Naturally the secondary deformity, while great, is one that only changes the physiognomy, leaving the face symmetrical with slight cicatrices.
Berger Method.—Berger advocates replacing a large loss of skin from the lower lip, the result of burns, lupus, or syphilitic ulceration, by employing a pedunculated flap made from the arm. ”

“ Usually there is pallor of the face which may be followed quickly with a twitching of the facial muscles, and sometimes those of the hands and feet. In most cases the attack comes on without warning; the eyes become fixed and rolled backward; the twitching usually begins in the face and very soon the entire body is involved. ”

“ Where there is loss of skin due to injury or operative procedure the parts may heal by granulation, but as this requires much time, and the consequent cicatrice causes considerable deformity, the granulating or freshly made wounds are covered with so-called detached skin flaps or grafts, when the former methods of plastic surgery cannot be followed. ”

“ By incorrect breathing the facial aspect of the mouth-breather is variously modified and always for the worse; since the soft facial bones of youth are altered by the continual striking of an air-current on the roof of the mouth, which is pushed upward, distorting the whole face.”
“None of our children are distorted. You won’t find a better-looking lot anywhere,” challenged Mrs. Sharpless, the grandmother’s pride up in arms.
“True. None of them has had overdeveloped adenoids, except Betty. The others all breathe through their noses. ”

“ Above the gland reaches to the zygoma, and below to the level of the angle of the jaw, where a strong process of the deep cervical fascia, called the stylo-mandibular ligament, separates it from the submaxillary gland; indeed the parotid is often described as lying in a bag formed by deep cervical fascia. The outline of the gland is obscured by several processes, one of which, the facial lobe, runs forward, superficial to the masseter muscle, accompanying the duct. ”

“ The movement of the lip is not then a source of danger in displacing the mass, since the acute swelling of the lip tissue prevents its free movement for several days, which gives the injected mass an opportunity to establish itself and find its proper place. ”

“ When becoming embodied in the coagula of serum and antiseptic powder it prevents, by pressure, perfect union, causing a wider scar at such point, as well as endangering the asepsis of the wound by being pulled off accidentally, thus tearing it open and bringing on hemorrhage.
The appearance of the resulting scar in facial surgery is often of as much importance to the patient as the operation itself, therefore, all care should be exercised in bringing about the very best result. ”

“ We can hardly suppose that disuse would maintain or develop the projecting chin, increase its perpendicular height till the jaw is deepest and strongest at its extremity, evolve a side flange, and enlarge [10] the upper jaw-bone to form part of a more prominent nose, while drawing back the savagely obtrusive teeth and lips to a more pleasing and subdued position of retirement and of humanized beauty. ”