The lower angle of the wound is then drawn downward and united lengthwise with silkworm gut sutures, giving to the prolabium a protrusion or tip, which eventually retracts and causing the lip to assume a natural aspect. The method is shown in Figs. 155-157. [Illustration: FIG. 155. FIG. 156. FIG. 157. NÉLATON METHOD.] =Fillebrown Method.=—Fillebrown has devised a method where the vermilion border of the lip is entirely preserved, as in the preceding operation. His method can only be employed where the cleft is not extensive. He commences his incision at the red border at the outer left line, cutting upward and inward toward the median line a short distance (see Fig. 158), then downward to the red border of the lip, then upward and outward to the right of the median line, corresponding to the incision just made to the left of the median line. The upper angle of the cleft is now drawn down by its red border and the wound sutured, as shown in Fig. 159. This operation does not project a small triangle of the white skin into the vermilion border and gives excellent results. [Illustration: FIG. 158. FIG. 159. FILLEBROWN METHOD.] =Von Langenbeck, Wolff, and Sedillot Methods.=—The methods of von Langenbeck, Wolff, and Sedillot are somewhat similar to that of Nélaton. An incision is made slightly above the prolabium, following the angle of distortion and reaching outward to either side of the median line almost to the angle of the mouth. The raw edges corresponding to the defect are brought together by suture and a section of the prolabium is removed to overcome its overprominence, but not enough to entirely flatten the vermilion border (see Figs. 160-161). The latter is sutured horizontally to such part of the angular defect as has not been utilized in the median line, and also vertically as far down as its free border, as shown in Fig. 162. [Illustration: FIG. 160. FIG. 161. FIG. 162. VON LANGENBECK-WOLFF-SEDILLOT METHOD.] =Malgaigne Method.=—The method of Malgaigne differs in technique in that he utilizes a semicircular incision, which is made to include the upper angle of the defect. Both ends of this incision are continued horizontally outward to a required extent (see Fig. 163). The freed prolabial flaps are drawn downward, as in Fig. 164, and sutured vertically, as shown in Fig. 165. Two retention sutures are shown in the latter figure to overcome the tension of the lips _post operatio_. The semicircular incision should be preferred when the defect will permit it, since the unequal lengths of the two lip halves may thereby be more uniformly approximated, while the prolabium in being crowded downward overcomes the notchlike scar so common with the vertical-incision method. [Illustration: FIG. 163. FIG. 164. FIG. 165. MALGAIGNE METHOD.] =Gräfe Method.=—This method, as shown in Fig. 166, is, therefore, to be preferred when the defect is one of the first or second degree.