The sutures may be removed as early as the sixth day, but it is best to release the wound sutures about this time, and leave the tension sutures for two or three days later. It often happens that the entire wound has not healed by primary union, if this occurs and sufficient union has taken place in part of the lip, the wound should be allowed to heal by granulation. Should the entire wound separate on the removal of the sutures, the operator may attempt to secure healing of the wound by applying a secondary suture to bring the granulating surfaces together, although little is gained by this procedure as a rule. If reoperation becomes necessary, it should not be undertaken before six weeks or more have elapsed. At any rate not before the lip tissues have returned to their normal state. Inflamed tissues do not retain sutures well. It usually becomes necessary to perform small cosmetic operations after the healing of harelip wounds. Those should not be undertaken until the child is of such age as to insure a perfect result. SUPERIOR CHEILOPLASTY Plastic operations for the reconstruction of the upper lip are not met with often in surgery, except in connection with the various forms of harelip. When the latter is not the cause, deficiencies of the upper lip are due to the ulcerative forms of syphilis, and are occasioned by the ablation of epithelioma and carcinoma or the result of burns or lupus. Rarely the surgeon will meet with such a defect caused by dog bite or other traumatisms due to direct violence, as in railroad or automobile accidents. CLASSIFICATION OF DEFORMITIES OF UPPER LIP Berger has classified three degrees of this deformity, according to its severity, to wit: 1. The skin only is destroyed and the mucosa remains. 2. The mucosa has been partially destroyed with the skin, but a part of the free border of the lip remains and is attached to the cicatrix. 3. All the parts which make up the lip have been destroyed, and there remains neither skin, mucosa, muscles, nor the prolabium. The loss of substance of varying degree may involve either of the outer thirds or the median position of the lip, or its entire structure. For a more explicit classification the author divided these defects into: (_a_) Unilateral defect of the first, second, or third degree. (_b_) Bilateral defect of the first, second, or third degree. (_c_) Median defect of the first, second, or third degree. (_d_) Total loss of upper lip. This same classification applies to the defects of the lower lip. OPERATIVE CORRECTION OF DEFORMITIES OF UPPER LIP When the deformity is either of the first or second degree, one or the other of the operations for the restoration of congenital cleft just considered may be employed. When these are impracticable other methods must be resorted to.