Ofttimes, when it is impossible to obtain foreign mucous membrane, grafts may be taken from the inner surface of the lips of the patient. These grafts answer exceedingly well for conjunctival restorations, while the wound occasioned by their removal is closed by suture or allowed to heal by itself, if not too large, under boric-acid antisepsis. BONE-GRAFTING Bone-grafting, as followed by MacEwen, Ollier, Poncet, and Adamkierwicz, has been more or less successful. Their methods have been often employed in plastic facial surgery, as will be shown later. Their methods were later improved by Senn, who advocated chips of decalcified bone in place of bone taken from young or new-born animals, from which the bones under ossification have been utilized. Glück’s method of introducing pieces of ivory into bone defects may be of interest, but is applicable only to long bone implantations. The success of his method has yet to be practically demonstrated. Zahn and Fisher have used various foreign substances to overcome bone defects, but these do not interest the cosmetic surgeon to any extent, since other methods have been proved to give better results. These, however, belong to the subject of subcutaneous prothesis, and must be considered separately thereunder. HAIR-TRANSPLANTATION It may be of interest to know that Schweininger and v. Nussbaum have attempted to graft hairs upon granulating tissue by sprinkling the hairs, with their attached roots, upon the surface to be covered. If any of these lived and attached themselves the root sheath formed a scar center, and the hair dropped out after several days. CHAPTER IX BLEPHAROPLASTY (_Surgery of the Eyelids_) Plastic operations about the eyelids are necessitated by and for: I. Direct injury causing the loss of a part, one or both lids. II. Loss of tissue following excision of tumor. III. Loss of tissue, the result of gangrene or ulceration. IV. Injuries due to burn or acid wounds. V. The healing and cicatrization following lupus. VI. The cicatrization following inflammatory lesions of the orbital borders, especially those of the supra-orbital ridge. Since the upper lid lies below the supra-orbital ridge, the above cause is rarely met with. VII. For the removal of redundant tissue. The result of the above causes leads to eversion of the lid (ectropion). There may be cicatricial contraction of the conjunctiva leading to ectropion, however, but its correction is not strictly of a plastic nature and belongs principally to the oculist surgeon, and will therefore not be referred to herein. ECTROPION Ectropion is not uncommon, and involves the lower lid only in the great majority of cases. It may be partial or complete, according to the extent of cicatricial changes in the skin. [Illustration: FIG. 89.—DIEFFENBACH METHOD.] PARTIAL ECTROPION