To assure the operator of a thorough dissection he may inject the site with sterile water through the opening made with the knife, squeezing it out before injecting the nose. If the skin has had to be freed by surgical means the mass injected should be sufficient to overcome the defect almost entirely, to prevent the reformation of the bands of connective tissue which have been severed. Their re-establishment would mean an unequal development of the new connective tissue springing up from the injected mass, thus defeating the object of the operation. If no dissection has been done the defect should be corrected about two thirds and added to by a subsequent injection. The mass in either case should be well molded out, especially at both sides, to keep the nose as narrow as possible. There will be more or less widening ultimately following the organization of the mass. [Illustration: FIG. 294. FIG. 295. ANTERIOR MEDIAN THIRD NASAL DEFICIENCY AND CORRECTION THEREOF.] It is not uncommon to find a dividing wall of subcutaneous tissue about the articulation of the nasal bones and cartilages, as evidenced by a rising up or down of the injected mass above or below this line. If this be found, rather than break down this wall with the injection, it is deemed advisable to inject each chamber separately and mold the two masses after injection, as in the ordinary type of cases. =Inferior Third Deficiency.=—This deformity of the nose is due purely to a lack of development or a luxation of the cartilage of the septum and the upper lateral cartilages. The point or lobule of the nose is usually tilted upward and the subseptum curved upward at its middle third. The cause of this deformity is usually due to direct violence at some time in life, with improper replacement at the time of injury. Syphilis and intranasal catarrh, lupus and ulcerative diseases, are also causes. The skin overlying the defect may or may not be closely adherent, but is in most cases rather thickened and inelastic. It is therefore necessary, in most cases, to loosen the skin by subcutaneous dissection, done as already described before the injection is made. To rebuild such a nasal defect without dissection, except in such instances where the skin is quite elastic, is not to be advised, since the injected mass would be flattened, more or less, antero-posteriorly, giving the nose a broad and ugly appearance after the connective-tissue formation has been attained. It is with cases of this kind that paraffin injections introduced in the liquid form and of high melting points are usually expelled in a week or ten days, or even later, subsequent to a breaking down of the surrounding tissues and the resultant abscess. The best preparation to employ is the form of paraffin mixture advocated in the preceding operation used in its cold state and injected slowly, after the integument has been rendered mobile enough to permit the desirable correction. [Illustration: FIG. 296. FIG. 297.