Fig. 249.Fig. 250.Author’s Method.
Fig. 249.Fig. 250.Author’s Method.
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, andvice 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.
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, ofcourse, 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.
If a pedunculated flap is employed, it should be cut in such a way that the twisting or rotation of its pedicle will not be too abrupt, and thus cause gangrene.
The secondary wound is sutured with silk and heals quite readily under proper hygienic care (see matter on mucous-membrane grafting, page 101).
If, for traumatic reasons, a more extensive operation involving the whole lip structure is indicated, one of the harelip operations heretofore given will answer the best purpose.
The cosmetic surgeon is often called upon to correct the vermilion borders of the lips, the usual fault being a lack of sufficient of the delicate membrane to give an artistic appearance or form to the mouth, and in some rare cases the absence of the so-called “Cupid’s Bow” of the upper lip.
Surgical means are of little avail to correct or beautify such fault, and the cosmetic operator must resort to other means. The only practicable method at hand is the careful tattooing of the skin with rose pigment introduced into the skin, preferably with an electric instrument made for that purpose. The hand-tattooingmethod is slow, irregular at best, and much more painful because of this.
The part to be tattooed is first outlined and then tattooed in linear fashion parallel to the vermilion border presenting, working upward to the peripheral line. The color applied should be pale rose at the first sitting, to be gone over after healing has taken place, and repeated even thereafter until the desired shade has been attained.
The method and instruments involved in the above and the tattooing of scar tissue is fully described in a later chapter.