In simple cases where a triangular ablation has caused the flattening the defect can be overcome to a great extent by employing the subcutaneous method of Gersuny.
Author’s Method.—The author recommends a subcutaneous division of the scar line in cases permitting such procedure prior to the injection of the tissues. This is accomplished with a fine tenotome, which requires only the making of a small opening in the skin through which the filling can be introduced. A single suture may be made through the lips of the wound, which is tied immediately after the filling has been introduced to avoid the displacement or pressing out of the injected mass at this point, which is sure to result if the suture be introduced after the injection.
A secondary filling may be found to be necessary subsequently to obtain the desired cosmetic result. The process of subcutaneous filling is fully considered in Chapter XIV.
When the lower lip is extremely flattened by the tension of cicatricial contraction of burn wounds of the mental region with more or less ectropion of the lip.
Teale Method.—Teale advocates the following method:
Two cheek flaps are formed by making a curved outward and upward incision upon either cheek, terminating at the second molar tooth of the upper jaw and corresponding to the lines A, A, in [Fig. 245]. These terminate anteriorly in two vertical incisions about three quarters of an inch long, made through the entire lip structure down to the bone on a line with the canine teeth.
The upper extremity of the two vertical incisions are united with a horizontal incision through the thinned-out or everted prolabium.
The two cheek flaps are dissected off from the bone, the mucous membrane uniting them to the alocoli being freely divided.
A base surface is made along the alocolar border of the median portion of the lip between the upper extremities of the two vertical incisions first made.