Plastic surgery; its principles and practice . Fig. 240.—Method of correcting a notch in the center of the lip following an operationor double harelip {Berry and Legg).—i. The line AB represents the junction of the skinmargins. The shaded area CBD the mucous membrane drawn up at the point B. 2. Theblack lines indicate the incisions made through the lip to remove a diamond-shaped area oftissue. 3. The points E and P are approximated and sutured, thus lowering the centralportion of the lip. operation which has otherwise been quite perfect. In some cases thenostril may also have to be raised. In
Plastic surgery; its principles and practice . Fig. 240.—Method of correcting a notch in the center of the lip following an operationor double harelip {Berry and Legg).—i. The line AB represents the junction of the skinmargins. The shaded area CBD the mucous membrane drawn up at the point B. 2. Theblack lines indicate the incisions made through the lip to remove a diamond-shaped area oftissue. 3. The points E and P are approximated and sutured, thus lowering the centralportion of the lip. operation which has otherwise been quite perfect. In some cases thenostril may also have to be raised. In single harelip the entire line of union may be involved. Thus,the scar may be wide and unsightly, and the tissues thin owing toincomplete union of the muscular tissue of the lip, or the two sides of thelip may have been sutured so that they are out of alignment, one being. Fig. 241.—Types of bad results following harelip operations.—-r. Note the prominenceof the philtrum and the hitching up of the vermilion border. 2. The result of removal ofthe intermaxilla. 3. Note the closure of the nostrils. All of these cases were operated onelsewhere. All were the result of operations for double complete harelip with cleftpalate. on a higher level than the other. In both of these cases the nostril isusually flattened. The only rational method of procedure is to excisethe scar completely and perform the operation as if it were the primaryone. It is always more difficult to secure a satisfactory result in thesecases than in one which has not been previously operated on. PLASTIC SURGERY Only a portion of the line of union may be defective, the rest beingsatisfactory: either the upper portion close to the nose, in which casethe nostril is usually flattened, or the lower portion of the lip mav needattention. When only a portion of the lip is involved, correction ma
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