Where the deficiency is due to cicatricial contractions of the submental tissue the latter must be divided horizontally from one healthy border to the other, the parts freed well from all subcutaneous adhesions in the cellular structure. The head should be forcibly raised and a flap of skin be placed into the elliptical wound thus formed either by the rotation of a pedunculated neck or thorax skin flap or the implantation of Wölfler or Thiersch grafts. Carefully keeping the head in an extended position during the healing in of these grafts will overcome the primary defect, unless the lip itself, too, has become tied down, when the bridge flap method of Morgan or Zeis can be undertaken in conjunction with the skin-grafting method to correct the fault. LABIAL ECTROPION Eversion of the lip may be due to cicatricial contraction of ulcerative wounds, burns, and traumatisms of the skin, or it may be hereditary. In the latter case the entire lip structure is more or less overdeveloped, as in the negro, especially in the lower lip, so that the thickened lip droops forward and downward. This condition is termed macrocheila. Ectropion of the lower lip is more common than in the upper lip. The defect may be slight and only of cosmetic importance or it may be so extensive as to permit an overflow of the saliva from the mouth. 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. [Illustration: 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.