This half of the lip is freely liberated by dividing the buccal mucous membrane along the reflecting fold. Should the vermilion border be contracted upward along the median cicatricial line it is carefully cut away from the lip proper down to its normal margin. This strip is retained until the flap taken from the under lip is brought into position, when it is neatly sutured to the prolabium thus brought into apposition. If there be a redundancy of the freed prolabium after the median sutures have been applied it is cut away. The secondary defect in the cheek caused by the rotation of the flap is closed by suturing the raw surfaces together. The resulting mouth will be much smaller than normal, having a puckered appearance. A secondary operation, mentioned later, is employed to correct this. [Illustration: FIG. 202.—BUCK METHOD.] =Estlander-Abbé Method.=—Estlander and Abbé employed a transplantation flap of triangular form taken from the lower lip to restore median defects of the upper lip, whether due to a deficiency of the latter following harelip operation or the extirpation of a malignant growth. Where the tissues operated upon warrant such procedure this operation will give excellent results, leaving the mouth almost normal in shape and size. The lower pedunculated flap is made by cutting directly through the entire thickness of the lip, including the prolabium at _A_ (Fig. 203), and downward toward the median line to the point _B_, thence upward to the margin of the vermilion border at _G_, leaving the latter to form the pedicle of the flap _F_. The defect is freshened by either a median incision, _D_, _E_, or the ablation is made in triangular form. The flap _F_ is now rotated upward and sutured into the upper lip, as shown in Fig. 204. The triangular defect thus made in the lower lip is sutured along the median line. The prolabial pedicle of the flap _F_ is not divided until about the eighth day, when the vermilion borders of both the upper and lower lips are restored by the aid of the free stump ends, which are neatly sutured into position, as shown in Fig. 205. [Illustration: FIG. 203. FIG. 204. FIG. 205. ESTLANDER METHOD.] This operation may also be used in the unilateral type of defect. It will be described in the operation of the lower lip, where it is more frequently employed than in connection with faults of the upper lip. INFERIOR CHEILOPLASTY Apart from harelip operation, those for the separation of the lower lip are the most common about the mouth. This is due in a great measure to the fact that malignant growths so frequently attack this part of the human economy and almost exclusively in the male. Out of sixty-one cases von Winiwarter found only one female thus affected. It has not been determined whether the habit of pipe smoking has been a factor in establishing this unequal proportion, yet it is acceded to be the fact, so much so that neoplasms of the lip in men have been commonly termed smoker’s cancer.