Many surgeons have endeavoured to utilise almost, if not every particle of tissue bounding the cleft, notably Malgaigne, Nélaton, Henri, and Giraldés; but the principal objections to this are that it leaves the nostril wide and depressed, and the expression anything but agreeable, whilst in some of the plans suggested the muco-cutaneous line will be irregular. From my own experience of operations I am convinced that better results may be obtained by a free removal of tissue, principally from the outer or buccal half of the cleft; and in so doing the knife should always encroach upon the affected nostril, and thus the necessary diminution in the size of its aperture can be obtained. Bearing in mind the tendency of scar tissue to contract in all directions, it is obvious that the surgeon must so plan his incisions that the united lip shall be at first slightly longer vertically than is ultimately desired. The incisions, instead of being made parallel to the edges of the cleft, should be curved, with their concavities facing each other, so that when in apposition a vertical elongation may be obtained. To avoid the formation of a 𝖵-shaped notch, a result so liable to occur, a variety of methods of forming a _prolabium_ have been suggested and practised. Most of these aim at the formation of a protrusion which, exaggerated at first, will ultimately be reduced to normal dimensions by subsequent cicatrisation. Some surgeons (_e. g._ Mirault and Giraldés) are content with using the mucous membrane of one side only, and planting it on a prepared surface on the other margin of the cleft; whilst Malgaigne, Henri, and Stokes make use of labial tissue from both sides. My usual plan of procedure is a modification of that described by Dr. Stokes, though I have had recourse to other methods. Great care must be taken to make the incisions clean and at right angles to the skin. By some, however, the edges are bevelled, and when for any reason such is thought desirable it is important to remember that each side will need bevelling to a proportionate extent. The use of scissors for this purpose is sometimes preferred to that of the knife, but the difficulty of cutting cleanly appears to me much greater with scissors, however sharp, than with a scalpel. Various kinds of lip compressors have been suggested for controlling the hæmorrhage from the coronary arteries during this stage of the operation; but I agree with the majority of surgeons in considering that these are cumbersome, and quite unnecessary when one has intelligent assistants. The constant presence of such an instrument distorts the parts, and prevents the operator from seeing clearly how to plan his incisions. Nothing can be so well adapted for this purpose as the thumb and index finger.