Estlander’s operation, described on page 171, gives, perhaps, the best results in these cases, but the objection to this procedure to make up the deficiency in the other, and often necessitating a later stomatoplasty to overcome the oval shortening occasioned by the rearrangement of the prolabium. This, of course, is a matter of little consequence where the primary fault is due to the ulcerative inroads of syphilis or the cicatricial contraction following burns. At any rate, the triangular flap implantation method is to be preferred to any other cutting procedure. 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. The flaps _A_, _A_ are then brought together so that their vertical margins meet at the median line, where they are sutured. A few fine sutures are taken through the vermilion border. A secondary wound, _C_, _C_, at either side is thus occasioned (Fig. 246), which can at once be covered with Thiersch grafts or is allowed to heal by granulation. [Illustration: FIG. 245. FIG. 246. TEALE METHOD.]