Plastic and cosmetic surgery

by Frederick Strange Kolle

When the cause of deformity is due to a cicatrix of the skin, as often met with in the lower lip, a flap should be neatly raised by a V incision, as with ectropium of the lower lid on page 104, and the wound sewed in the Y form (Dieffenbach).

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.

In hereditary cases of mild form or partial ectropion the author advocates making two vertical incisions in the mucous membrane, half an inch long, one half inch distant from the median line of the lip, and suturing them horizontally, as shown in [Figs. 247 and 248].

Fig. 247. Fig. 248.

Author’s Method.

In some cases the ectropion, whether partial or more or less general, is caused by protrusion of the teeth either of the upper or lower jaw; more commonly of the alveolar structure of the superior maxillary bone. In such cases a cosmetic operation on the mucosa will do little to restore the deformity. Such cases should be corrected primarily by a surgeon dentist, the teeth being forced back into place by proper metal springs or splints—a tedious process requiring from six months to two years’ time.

If, after the teeth have been brought back to the normal bite, the lip still shows an abnormal contour, the surgeon may restore this by several small incisions in the mucosa, as above advised, at the various protruding points of the lip.

When the simple vertical-line incisions sutured horizontally will not accomplish the result, the excision of small triangles or elliptical pieces of the mucosa may be made, bringing the distal edges of the wounds together horizontally with silk sutures, which are found best for suturing wounds about the buccal cavity.

The same methods as above given apply to the correction of upper-lip deformities.