38

WITH

LENGTHENING
CENTRAL

THE COLUMELLA TISSUE

LI

PROLABIUM
IF

IN

THE

LIP
INTO THE FULL VERTICAL LENGTH
11

THE PROLABIUM WAS INCORPORATED THE LIP PROBABLY TIME

WILL

OF THE LIP IN FACT IN MUSCLELESS ABOUT

THIS

HAVE ADEQUATE
LIP

WIDTH AND LENGTH

WILL STRETCH

THE MUSCULAR

LATERAL

ELEMENTS VICTOR

THE

PROLABIUM
ASPECT

WIDE

AND

FLAT

VEAU

COMPLAINED

THE PRINCIPAL
REPAIR
IS

CAUSE OF THE MEDIOCRE

RESULTS

OBTAINED

IN

BILATERAL

CLEFT

LIP

THE ABSENCE OF MUSCLE IN

THE PROLABIAL SEGMENT OF THE LIP THE NORMAL ONLY IF THE LIP FACT THE MUSCULAR
STERILITY

ONE

CAN

HOPE

FOR

CONTOUR AND SHAPE APPROACHING HAVE LONG EMPHASIZED

THIS

CONTAINS OF THE

MUSCLE
PROLABIAL

SEGMENT
THERE

AT

LEAST

IS

EXTRA

LIP

TISSUE

AVAILABLE

FOR

LENGTHENING

THE

SHORT

COLUMELLA

SHIFTING
WHEN THE
THE

THE
LIP
IS

TOTAL
IT

PROLABIUM
FLAP FOR LENGTHENING AS

UPPER

AMPLE

CAN SUPPLY

COLUMELLA

THIS

FLAP CAN BE THE ENTIRE

PROLABIUM

WAS USED AND

LATER

BY BARON DUPUYRREN
DIRECT

ALONG WITH EXCISION LIP

OF THE PREMAXILLA
PRINCIPLE

SIDETOSIDE
TO

CLOSURE OF THE CORRECTIONS

CREDIT FOR

THE

WAS

ADAPTED DAVIS

SECONDARY
FERRIS
IS

PESKOVA AND FARA GAVE

ATTRIBUTING
THIS

AND

SMITH
POSSIBLY

APPROACH

TO

GENSOUL THIS
BOTH DAVIS

LANGUAGE

MISINTERPRETATION

BECAUSE
AS

AND SMITH

DESCRIBE

GENSOULS METHOD CORRECTLY

OUT OF THE CENTER OF THE PROLABIUM AND NOT THE ENTIRE

PROLA

BIUM
TO

IN

FACT DAVIS THE CENTER

ALSO ILLUSTRATED

VERTICAL

COLUMELLA

EXCISION

THIN

COLUMN

SIMULTANEOUSLY

WITH

THE

GENSOUL

LENGTHENING

481

GILLIES

TAUGHT

ME
IT

TO SHIFT

THE ENTIRE
TYPES

PROIAOIUM

IN

CERTAIN

CASES

AND
NASAL

HAVE USED

IN

MANY

OF COMBINED
IT

SECONDARY BILATERAL AN

AND

LABIAL IN
ITS

CORRECTIONS

USUALLY
IN

REQUIRES

ABBE

FLAP

REPLACEMENT

WAKE AND

THE RIGHT
IN

CIRCUMSTANCES

THE RESULT

CAN BE QUITE DRAMATIC SCHOOLTEACHER PUBLISHED

AS DEMONSTRATED IN PLASTIC

THE CASE OF THIS

YOUNG

AND

RECONSTRUCTIVE

SURGERY APRIL

1963

482

WHEN AND HOW

THE
WHEN

TO

SHIFT

TOTAL
THE COLUMELLA LIP
IS

PROLABIUM
IS

SHORT AND THE

UPPER

LIP

TIGHT
IS

IN

RELATION

TO THE LOWER TOTAL

REDUCTION TAKEN
INCISION

OF THE LOWER LIP

NECESSARY UNIT

THE

PROLABIUM

OUT OF THE UPPER LIP EXTENDED

AS

AFTER RELEAS

MEMBRANOUSSEPTAL
ING INCISIONS

BY LATERAL VESTIBULAR

THE COLUMELLAPROLABIUM

COMPONENT

HANGS

FROM
INTO

THE TIP

OF THE NOSE LIKE

TAKES BIT

PINGPONG PADDLE TO
OF CLEVER TAILORING

TURN THIS

COLUMELLA

EXTENSION

FLAPS AT THE TOP OF THE

PROLABIUM CAN BE USED

THE REMAINING

TO

FILL

THE LATERAL VESTIBULAR THINNED

THE TRUE

INCISIONS

THEN

PROLABIUM

IS

AND

ROLLED

ON

ITSELF

WITH

SUTURES

THE

JOIN

OF THE END OF TENDS TO

COLUMELLA

TO THE

BEGINNING
IF
IT

OF THE PROLABIUM

RESIST IN

SMOOTH TRANSITION
FIRST

DOES NOT FORM

REVISED

GRACEFUL COLUMN
VERTICAL

THE

STAGE

IT

CAN

BE

WITH
OF THE

DIAMOND

EXCISION

SECONDARILY
AS

THE BOTTOM END

BASE TO JOIN

PROLABIUM CAN BE

SPLIT

TO SPLAY FLOORS TIP

COLUMELLA
SILLS

THE ALAR BASES ACROSS THE

CARTILAGE STRUTS TO SHORE

NASAL

AS NOSTRIL

AGAIN

SEPRAL

UP THE
SEVERAL

AND COLUMN CAN BE USED PRIMARILY

OF THIS DOUBLE ACTION
WILL

OR SECONDARILY

EXAMPLES

BE

SHOWN LATER

OTHERS

USE THIS GENERAL PRINCIPLE

OF ADVANCEMENT OF THE ENTIRE

FILLING

PROLABIUM INTO THE COLUMELLA AND

AN

THE UPPER LIP DEFECT WITH OF THIS APPROACH

ABBE

FLAP

THE MOST

RECENT

WAS

REN

MALEK

OF PARIS

1973 ADVOCATE WHO WHEN TAKING

COLUMELLA

FROM WHICH

BELOW

ELUCIDATED

THE TYPE OF BILATERAL

SECONDARY CASES IN

HE PREFERRED THIS

REGIMEN
ELEMENTS
IS

ONE

OR MORE OF THE FOLLOWING

EXISTS

THE MEDIAL

PART OF THE LIP

IS

TOO SHORT IN
IS

HEIGHT THE PROLABIUM

THERE
IS

SCARRED AND THE MUCOCURANEOUS RIDGE OF THE LIP

IN

DISTURBED

TRANSVERSE SHORTENING APPEARANCE AN ABBE

CAUSING

ACCORDING IN

TO
ALL

VICTOR

VEAU
IT IS

HOLY WATER BASIN NECESSARY TO UTILIZE

THE PROFILE

VIEW

THESE CASES HEIGHT

FLAP

THE PROLABIUM

GIVES ADDED

TO THE COLUMELLA

GENSOUL
MORE
POPULAR COLUMELLA LENGTHENING APPROACH
FOR

OVER PORTION

CENTURY WAS THE USE OFA FLAP TAKEN OUT OF THE MIDVERTICAL

483

OF THE PROLABIUM

IN

CONTINUITY

WITH THE BASE OF THE COLUMELLA ADVANCEMENT

THIS HAS

AND

SHIFTED

UPWARD BY

VY

BECOME

KNOWN

AS THE

GENSOUL PRINCIPLE
PARIS

JOSEPH GENSOUL OF H6RELDIEU

SIVE AUDACIOUS
FIRST

WAS

DEXTEROUS EXPLO
SANGFROID IN 1833 THE

SURGEON WITH
TO CONCEIVE FINE

AN IMPERTURBABLE SECONDARY LIP

HE WAS THE

VY

TO LENGTHEN

COLUMELLA AND MANY

THIS

SURGEONS SINCE

HAVE USED AND MODIFIED

PRINCIPLE

THERE WAS ONE MAJOR DRAWBACKIT

DOUBLY
SCARRED

ADDED

THIRD

SCAR TO

THE ALREADY

LIP

JOSEPH GENSOUL

UK

GILLIES
GILLIES

USED IT
DESCRIBED LANCET
OF DOUBLE
LIP FOR

AND KILNER
THE 1932

TREATMENT

OF THE BILATERAL

CLEFT

LIP

NOSE IN

ONE

OF THE MOST

COMMON
IS

FAULTS

IS

FOUND

IN

CASES

HARELIP

THE

SOCALLED PROLABIUM NOSE

IS

OFTEN PLACED SO FAR

IT

DOWN THE

THAT THE LOBULE OF THE OF THE PROLABIUM VARY PART OF THE LIP

DRAGGED

DOWN WITH
IF

THE

VERTICAL

DIMENSIONS

CONSIDERABLY THEN
TIES
ITS

THE SKIN
IN

OF THE PROLABIUM WERE TRULY

LIP
IT

INCORPORATION

THE

SHOULD

LEAD

TO NO SECONDARY
AS

DEFORMI
SKIN

ONE MIGHT
THE COLUMELLA

DESCRIBE
TO

PROLABIUM
LIP
IT

THAT PORTION

OF THE

JOINING

THE UPPER
LIP PLASTIC

THE MIGHT BE BETTER TERMED

IT IS

EF

SUPRALABIUM
II CASES

FROM

POINT

OF VIEW

IMPERATIVE OUR OF THE

IN LIP

ALL

OF
IT

DOWN DRAWN
SO HIGH

NOSE TIP
FREE

TO TAKE THE PROLABIAL

SKIN

AND
OF

SUTURE

UPON THE

BORDER OF THE SEPTUM AS WILL

ALLOW THE RIP

NORMAL POSITION THE NOSE TO COME FORWARDS AND UPWARD INTO

TO

ENSURE THIS

MAY BE
ARE

NECESSARY TO DIVIDE

THE MEMBRANOUS SEPTUM WITH

SCISSORS WHICH

CARRIED EVEN OVER THE ANTERIOR BORDER OF THE SEPTUM THE LIP

THERE REMAINS AND

VSHAPED GAP IN

THE

SKIN OF THE LIP

THE FLOOR OF THE VESTIBULE

THE BASE OF THE ALA ARE CAREFULLY

UNDERMINED
IS

TO LOOSEN THE FALSE ATTACH TO GATHER THE DEEP

TISSUE

MENTS

BURIED

CATGUT SUTURE

INSERTED

484

TOGETHER TO SUPPORT
IN

THE COLUMELLA

FROM BELOW AND BEHIND THIS

THE NOSE
STILL

STITCH

DRAWS
THE

AND SO IMPROVES THE ALAR BASES

FURTHER BY NARROWING

NOSTTIL5

IN
TO

SOME

CASES

THERE

IS

INSUFFICIENT

SEPRAL GRAFT

DEVELOPMENT TO GIVE PROMINENCE

OF CARTILAGT
IS

THE NEW TIP

AND

SUPPORTING

RCQUIRCD LARCR

LEXER
ERICH

USED

IT
SAUERBRUCH THE
AS CHIEF FLAP
IT

LEXER
IN

WHO SUCCEEDED
1928
THE
ALSO

OF SURGERY IN

MUNICH
UNLIKELY

USED

GENSOUL

MIGHT
IN

SEEM
ARTERIAL

THAT

GRANDIOSE

LEXER

WHO

REVELED

ANEURYSMS ARTHOPLASRIES JOINT REPLACEMENTS WOULD EVEN NOTICE SHORT COLUMELLA ESOPHAGOPLASTIES
OF IT ONLY TOOK NOTE
THE

AND JEJUNODERMATO

HE
IT

NOT
AT

HE DESIGNED
FLARING

PROCEDURE

TO CORRECT

AND

SAME TIME

NARROW THE

MAE
SOMEWHAT OVERPOWERING ONE OF
HIS

OF GREAT
AS TESTIFIED

PHYSICAL

STRENGTH LEXER

BY HANS

MAY WHO WAS

STUDENTS

1E
THEIR

NEVER HAD MORE THAN TWO ASSISTANTS

FINGERS

HELPING
LIKE

HIM AND

THEY HAD TO KEEP THE

OUT OF THE

WOUND AT

ALL

TIMES

TO BE ALONE IN OF ORDINARY

WOUND

WAS AN OFTEN QUOTED REQUEST OF HIS

THE

HANDLING

INSTRUMENTS
TABLE

WAS CALLED FOR BY SIGN LANGUAGE AND CONVERSATION AT THE OPERATING

AT

KEPT

MINIMUM WEEKEND HE INVITED ONE OF

ON

HIS

ASSISTANTS FOR

TO JOIN

HIM

IN

HIS

TWOOAT BOAT ROWING ON LAKE CONSTANCE

WAIST IN

HOURS STRIPPED
SUFFERED

TO THE

THE BLAZING

SUN AND WHEN

THE ASSISTANT

BURNS

AND EXHAUSTION AND

BOTTLE

HE WAS TREATED BY IMMERSION IN

TO REPLACE FLUID

TUB OF ICED WATER

OF CHAMPAGNE

BALANCE RULER

YET LEXER
STUDIED THE

HAD AN

ARTISTIC

EYE AND NEVER USED

HE

HAD

ART BEFORE

MEDICINE

AND COULD USE THE PAINTERS

AS THE

BRUSH OR

SCULPTORS

CHISEL

AS MASTERFULLY HIS

SURGEONS KNIFE
PLASTIC

THIS

FACILITY

PROBABLY
TO

EXPLAINS

ENJOYMENT OF

SURGERY AND

WILLINGNESS

LENGTHEN

COLUMELLA

SO

DID

MCINDOE
MCLNDOE OF
149 HARLEY STREET
TRAINED

SIR ARCHIBALD VICTORIA THE FL

LONDON AND QUEEN

IN

HOSPITAL CLINIC

EAST GRINSTEAD

GENERAL SURGERY AT

MAYO

WHERE

IT

WAS REPUTED

HE COULD

PERFORM

485

CHOLECYSTECTOMY OF HIS
ALSO

AS ADROITLY IN

AS

ANYONE

AT THE CLINIC RELATIVE

DURING

THE

LAST

SEVEN YEARS

ROCHESTER
HE

DISTANT

OF GILLIES

AND
OF SIR

FROM

NEW

ZEALAND

CAME UNDER THE

FOR HIS

TUTORSHIP

HAROLD GILLIES AIRMEN DURING

YAL COLLEGE

WAS KNIGHTED
THE
BATTLE

GREAT

WORK ON
AN

THE BURNED OF THE

OF BRITAIN

BECAME

OFFICER

OF SURGEONS AND WAS UNDOUBTEDLY ONE OF THE TOP SURGERY IN THE WORLD IN STUDENTS 1959

TECHNICIANS

AND SHOWMEN OF PLASTIC

MCLNDOE CONSORTED WITH ONE

SIR

OF HIS FAVORITE

TOM REES

ARCHIBALD

MCIND

OF

NEW YORK
THE

TO DESCRIBE

GRAND AND SYNCHRONOUS SECONDARY USING

THE MODIFICATION OR
THIS

CORRECTION OF CLEFT LIP AND NOSE DEFORMITIES OF

GENSOUL
OF
IT

PRINCIPLE

THEY

ELEVATED

PROLABIUM
TIP

PORTION

LIKE

TRAPDOOR BASED ON THE NASAL

AND WITH

OPEN DOOR EXPOSURE

BILATERAL

REMOVED THE

HUMP WITH
PIECE

CHISEL

AND SAWED

OSTEOTOMIES

THE PROLABIUM
INTO

WAS THEN ADVANCED AND THE

LIP

COMPLETELY

OUR OF THE LIP

THE COLUMELLA

CLOSED

WITH

ZPLASRYBUT

ALAS

WITHOUT

PHILTRUM

SUAVE YORK
STREET EARLY

TOM

REES

WHO HAS

ATTRACTED

AN ELITE
TO

CLIENTELE

OF

NEW
HIS

SIMILAR

TO

THE ONE THAT

PILGRIMAGED

MCLNDOES
REMINISCED

HARLEY

CONSULTING DAYS WITH

ROOMS
SIR

IN

LONDON

RECENTLY

ON

ARCHIBALD
TO THE ROLLS

PARTICULARLY REMEMBER DRIVING

QUEEN VICTORIA ROYCE

IN

HOSPITAL HE

ON MONDAY

MORNINGS WITH
COMPLETELY READY
TO

ARCHIE

IN

HIS FULL

WHICH

WOULD BE IN
FEELING THE
FIR

MERRY TACKLE

MOOD

OF GOOD CHEER AND GENERALLY IMMEDIATELY

AND

NEW WEEK
LITERALLY

UPON

ARRIVAL

AT

HOSPITAL TO
FOR

HOWEVER HE WOULD
SEVERAL

TEAR

THE PLACE APART WHICH HE ADMITTED

JUST

ME
THE

YEARS

LATER

HE DID ON PURPOSE

TO

GET

THE TROOPS IN LINE

COMING

WEEK
ARCHIE

CERTAINLY

HAD GREAT CHARISMA

HE WAS AWARE

OF THIS

AND WAS ABLE

TO

486

EXERT

HIS

MAGNETISM

IN

MUCH

THE SAME WAY AS

FAMOUS POLITICIAN
HANDS WITH

OR EVEN

KNOW HE HAD ENORMOUS HAMLIKE MOVIE STAT AS YOU

INTRICATE COULD DO THE MOST SEVERAL CLEFT LIP

WHICH HE
ARCHIE

AND

DELICATE

SURGERY

HELPED

DO
OF

RATHER

RADICAL

OPERATIVE

APPROACHES COMPLETE

TO THE SECONDARY DEFORMITIES TAKE

NOSE IN

WHICH HE DID

DOWN OF

ALL

ELEMENTS

OF THE

LIP

NOSE AND RECONSTRUCTION WITH

WITH

SUBMUCOUS RESECTION
AN

NASAL PLASTIC

AND

RESTORATION OF THE LIP

OR WITHOUT

ABBE

FLAP

TRIFOIL
VILRAY BLAIR

OF WASHINGTON
CALLED

UNIVERSITY

ST

LOUIS
CLEFT

WHO

IN

HIS

PRIME

WAS

UPON

TO

DO MANY SECONDARY
WITH
LATERAL

CORRECTIONS
TO
FILL

MODIFIED
RELEASING

THE GENSOUL PRINCIPLE

INCISION IN FLAP

EXTENSIONS

THE THIS

MEMBRANOUSSEPTUM BY WHAT

HE REFERRED

TO AS THE TRIFOIL

PROCEDURE TENDED TO SHORTEN THE VERTICAL

LENGTH OF THE LIP

BLAIR THE FLAP

ALSO USED

THEVY

PRINCIPLE

IN

THE NASAL
IT

TIP

HE

CALLED
TRIFOIL

IT

BATWING
AS

PROCEDURE

AND OFTEN COMBINED

EFFORT TO

WITH
THE

HIS

CONSECUTIVE

SECONDARY

INCREASE

NASAL

TIP

REFINEMENT
THESE

AN ADVANCEMENT ON TOP OF AN ADVANCEMENT THE

HE

USED

TWO MANEUVERS MANY TIMES DURING

DESCRIPTION IN

20S

30S AND

40S

HIS

1930

IS

TYPICALLY

LUCID

IN

THE BARWING THE MATERIAL

COMES FROM THE NOSE AND COLUMELLA BY CUTTING

THE MESIAL

THROUGH THE CARRILAGES PORTION OBLIQUE

OF THE COLUMELLA AND NASAL TIP AND SUTURING BRINGS THE

TIP

FORWATD THIS
SLANT TO THE

OF THE

NOSE

FORWARD GIVES

MOTE

NOSRTIL AND NARROWS THE COLUMELLA

HERE
IN PLASTIC

ARE

TWO CASE EXAMPLES PUBLISHED

RECONSTRUCTIVE

BY BLAIR

AND LETTERMAN

AND

SURGEIY

JANUARY

1950

487
II

FLEURDELIS
IN 1941

BROWN AND MCDOWELL

FLEURDELIS

REDUCED BLAIRS EXTENSIONS

TRIFOIL

TO

SMALLER OF THE THE

SLEEKER

WITH

LATERAL

NEAR THE FLOOR

VERTICAL

NOSE HERE AGAIN UPPER LIP

TIP

THE DONOR AREA ADDED

THIRD

SCAR IN

BUT

THE PROCEDURE

DID PRODUCE COLUMELLA

LENGTH WITH

ELEVATION

71
IN 1947

BROWN MCDOWELL AND

COLUMELLA LENGTHENING SUPPORT
NOSE

BYARS ACKNOWLEDGED THAT THEIR

AT THREE

FLEURDELIS

AND

HALF YEARS

OF AGE

OFTEN REQUIRED
FURTHER ELEVATION

CARTILAGE

AT

SIX

YEARS

OF THE

MAY

BE

OBTAINED

WHEN

DESIRABLE

BY

AN

LSHAPED

PRESERVED

CARTILAGE

TRANSPLANT

IN
IN

1966

FRANK MCDOWELL REVIEWED COMPLETE

CLEFTS

THEIR

LATE RESULTS

AND NOTED

THE BILATERAL

FURTHER PROBLEM IN THE PATIENTS

WILL

THE DOUBLE

CLEFT

IS

THE SHORT COLUMELLA

ABOUT HALF OF AND

WILL

GROW
THIS

COLUMELLA CONDITION

OF MINIMAL

NORMAL LENGTH

REQUIRE NO SURGERY FOR

THE

OTHER HALF WILL CONTINUE

IS

RO HAVE

COLUMELLAS SO SHORT THAT THE TIP ESTABLISHED BETWEEN

OF THE NOSE

SNUBBED

DOWN IR

SEEMS WELL

NOW THAT

THESE SHOULD

HAVE SURGICAL ELONGATION

OF RHE COLUMELLA IN

THE AGES OF

AND

YEARS THE METHOD WE USED WAS PUBLISHED

1941

488

STUDY

OF THESE
IT

CASES

REVEALED THAT
JUST

WHEN

THE COLUMELLA

WAS NOT AND

THE
IT

LENGTHENED

WAS OFTEN

SHORT ENOUGH TO DRAG THE TIP COLUMELLA

LIFT

HOOK THE
CENTRAL

NOSE

WHEN
IT

THE

WAS LENGTHENED
THE TIP SCAR ADEQUATELY

BY

FLEURDELIS CREATED
AS

DID NOT ALWAYS

THIRD

AND

INVARIABLY

MIDLINE

LIP

YET

AS LATE

1974

BROADBENT AND WOOLF WERE ADVOCATING

MINOR DEGREES OF DEPRESSION CAN BE IMPROVED WITH

COLUMELLA

VY

PROCEDURE

ON THE

AND TIP

THEIR PETIT STATED

TINY

VY

MANEUVERS ACTED

AS

PETIT

OMBREDANNES
OF THE

AND

GENSOULS DEPENDING ON

THE

DIRECTION

THEY

MINOR AND MODERATE DEGREES OF DEPRESSION ASSOCIATED WITH

NASAL

BILATERAL

CLEFT

LIP
ITS

DEFORMITY

CAN BE IMPROVED BY SPLITTING THE DEFECTS WITH

FREE

THE COLUMELLA OR LOCAL

EXTENDING

HALVES AND COVERING

GRAFTS

FLAPS

THE

CASES

THEY PRESENTED

USED

VY

TYPE OF FLAP AND SEEMED TO

PRODUCE TOO

MUCHSCARRING

FOR THE LIMITED

AMOUNT

OF TIP

RELEASE

LATERAL
IN 1954

VESTIBULAR

VYS
IN TO

JOHN

POTTER OF STOCKTONONTEES
CORRECTIVE

NORTHERN

ENGLAND

ADDED AN IMPORTANT TION

FIRST

DIMENSION

THE GENSOUL OPERA

HE OUTLINED

THE

PROBLEM
NASAL TIP
IS

IN

BILATERAL

CLEFT

LIP AT

CASES THE TIMES

USUALLY DEPRESSED WITH THIS

IS

SHORT

COLUMELLA

WHICH

SEEMS ALMOST

NONEXISTENT

DUE TO THE
SHORT MEDIAL

SHAPE OF THE UNDERLYING

ALAR

CARRILAGES WHICH HAVE EXTREMELY

IS

COLUMELLAR CRURA THE CONDITION

THE CONDITION
LATERAL
IS

SIMILAR

TO

THE

FLAT

UNILATERAL CASES ONLY

IS

BILATERAL

THE

ARCH OF THE ALAR CARRILAGES

FLATTENED AND THE

PORTIONS OF THE CARTILAGES

ARE FREQUENTLY ROTATED INFERIORLY INTO THE NOSE CAUSING

AND SO

THEIR

OUTER SURFACES OBSTRUCTION THE NOSTRILS

ARE SEEN PROJECTING

ALAR

DEGREE OF NASAL OF

THE
IS

MARGINS

TEND TO BE EVERTED LATERALLY THE APPEARANCE

LOW AND WIDE INSTEAD OF HIGH

AND NARROW

489

OBTAINING
IN DETAIL

EXPOSURE THE MEDIAL

BY THE GENSOUL OPERATION

POTTER EXPLAINED
ALAR CARTILAGE FLAPS

VY
SKIN

ADVANCEMENT OF
IS

HIS

THE AMOUNT

OF PHILTRUM

REQUIRED

ESTIMATED SKIN
LINE

IN

EACH CASE TO GIVE

IS

COTRECT LENGTH INCISION

OF COLUMELLA
SIDE
IS

THE

PHILTRUM ALONG

REQUIRED

RAISED

AND RH
TO THE

ON EACH

CONTINUED

MM
BORDER
IS

POSTERIOR

COLUMELLAR
ALAR

MARGIN TO THE NASAL RIP AND THEN FOLLOWS THE LOWER BORDER OF THE

CARTILAGE

THEN

TURNS

HACK
ITS

ALONG

THE UPPER

OF THE ALAR

CARTI

LAGE

THE
IS

CARTILAGE

WITH

OVERLYING MUCOSA NASAL

RIP

THEN FREED FROM THE SKIN

AND

FULLY

MOBILIZED
IS

THE

SKIN

IS

WIDELY

UNDERMINED
ARE

THE
INTO

COLUMELLAR
THEIR

FLAP

RETRACTED UPWARDS AND THE ALAR CARRILAGES TO EACH OTHER

SUTURED
LATERALLY

CORRECT POSITIONS AREA

IS

THERE
BY SUTURES

IS

RAW AREA

THIS
IS

UNDERMINED AND
INTO
ITS

CIC

THE

COLUMELLA

SKIN FLAP
IS

THEN

SUTURED

NEW POSITION
AIDED BY AN INCISION ATTACHMENT FOR

THE

DEFECT IN

THE PHILTRUM

CLOSED BY APPROXIMATION
IT

IN THE ALAR SULCUS AND SHORT DISTANCE

CARRYING

AROUND THE

LATERAL

ALAR

AGAIN
OF SUCCESS
II

THE PRINCIPLE
IN

IS

SOUND AND PROBABLY

DEFORMITY

HAS

BETTER

CHANCE
TO

THE BILATERAL
IT

MANY
IN

SURGEONS CONTINUE
NASAL

INCORPORATE

ONE WAY OR ANOTHER

THEIR

CORRECTIONS

CONDEMNATION FROM BEHIND

THE
IN 1960

IRON
11

CURTAIN
FARA OF CHARLES UNIVERSITY
FLAP

PESKOVA AND
THE

PRAGUE
OF THE

COMMENTED ON
PROLABIUM
THIS TO

WEDGESHAPED

FROM THE MIDDLE

LENGTHEN
IS

THE COLUMELLA DOCKHORN

OPERATION

USED HY

BROWN RAGNELL BENAIM

OF THE COLUMELLA
FOR
IS

KIRCHSTEIN SMALL

AND OTHERS LENGTHENING

SEVERE DEFORMITY THE
LIP
IS IS

ONLY

HOWEVER AND IN
VERTICAL SCAR

NOR SUFFICIENT

SATISFACTORY

RESULT

THE

OF

DISFIGURING

AND IN

CHILDREN

CAN UNDERGO HYPERRROPHY

MOST SURGEONS HAVE COME

TO

AGREE WITH

THIS

STAND BUT

FOR

MANY
CENTER

YEARS

THIRD

VERTICAL CLEFT

SCAR LIPS

WAS BEING WITH

ONLY

ADDED ROUTINELY
INADEQUATE

TO THE

OF BILATERAL

COLUMELLA

LENGTHENING

490