_The Indian or Hindu Method_ The method of rebuilding the nose by taking one or two flaps from the forehead dates back to the Koomas, from whom the art of rhinoplasty has come down to the present time, all of the methods of to-day involving the utilization of the pedunculated flap being a result of their early surgical ingenuity. Originally, their operation consisted of cutting an oval flap, having its pedicle as the root of the nose, and extending over the forehead, and upward vertically into the hair line. The flap thus made was dissected away from the bone and brought down by twisting it to the extent of a hundred and eighty degrees on its pedicle in front of the nasal deformity, the edges of which had been prepared to receive it. To hold the flap in position they resorted to some kind of clay, sutures being unknown to them. The pedicle was cut after the flap had thoroughly united to the freshened borders of the deformed nose. The steps of the operation as performed by them are shown in Figs. 314, 315, and 316. Naturally, many improvements in the above method have been evolved, principally to overcome the extreme and injurious torsion of the pedicle, and from the desire on the part of the surgeon to bring about a better cosmetic result. Therefore, not only the position of the pedicle and its shape were altered, but also the size of the flap itself, as will be shown in the specific methods of the various authorities mentioned hereafter. The author does not consider it necessary to go into chronological details of the evolvement of the art, and begs the surgeon to be content to learn of those operations and methods that have given the best result. [Illustration: FIG. 314. FIG. 315. FIG. 316. KOOMAS METHOD.] Where one surgeon has changed his incisions in the slightest direction and another has advised increasing the number of sutures is of little import to the operator of to-day; the gist of it all is the successful method for the successful outcome. The first to be considered will be those methods wherein the vertical direction and the position of the pedicle have been similar to that of the Koomas. It will therein be noted that the principal change has been in the formation of the distal end of the flap with the object solely of forming a better base to the nose. =Graefe Method.=—The flap was made in the shape of a heart with a rectangular addition at its upper or scalp border. The pedicle is made to lie between the inner limitations of the eyebrows (see Fig. 317). The flap is twisted into position and sutured into the freshened remains of the nose, the pedicle being cut at a second operation after the flap has healed into place, which was about the tenth day. [Illustration: FIG. 317.—GRAEFE METHOD.] =Delpech Method.=—The shape of the frontal flap was cut in the form of a trident, as shown in Fig. 318.