Plastic and cosmetic surgery

by Frederick Strange Kolle

Where the fault is too great to be overcome by this method, the author advocates removing an elliptical or diamond-shaped piece of the lip from the inner surface or mucosa, the whole length of the lip and wide enough to correct the fault, as shown in [Fig. 249], and bringing together the margins by an interrupted suture, as in [Fig. 250]. This is the most satisfactory method to restore either the upper or lower lip to normal position. The resulting cicatrix of the mucous membrane offers no objection whatever, and soon becomes obliterated.

Fig. 249. Fig. 250.

Author’s Method.

If the operator feels justified to remove a triangular piece, with its base upward, in case of the lower lip, and vice versa, from the whole thickness of the lip he can do so, but the operation has the objection of leaving a noticeable vertical scar in the skin and a notch in the vermilion border.

The former can of course be materially hidden by the mustache or beard in man.

LABIAL ENTROPION

While labial inversion is in most cases caused by the removal of tissue from the inner or whole lip structure due to disease or other causes, it may nevertheless be met with in hereditary instances. The condition is termed microcheila.

It is more common in the upper lip, perhaps because of the frequency of harelip corrections undertaken with that part of the mouth, but it may involve both lips or be partial in one or both lips; in the latter case often the result of the habit of talking, chewing, or laughing with one side of the mouth, in which the active side is the normal and the passive side the one showing a lack of development.

In the latter case daily facial gymnastics should be advised, and such teeth as need attention to permit of the use of the side favored should be restored to usefulness—the loss or uselessness of teeth in the earlier days of puberty often causing the deformity. The correction of such defect has in view to widen the lip structure, and the best method to follow is the suturing of one or more horizontal incisions in a vertical direction, these incisions depending in number upon the extent of the lack of tissue, whether total or partial. This, of course, overcomes only the rolling in of the vermilion border, and does not in cases of the extensive variety overcome the deformity. In such cases an incision is made through and along the entire mucosa half an inch below the vermilion border. The incision should be made deep enough to permit of free movement of the upper section of the lip, which is drawn up by an assistant, while a flap of mucosa, either pedunculated or free and taken from the inner side of the cheek in the near vicinity to the lip, is sutured into the opening thus made by traction.