=Blasius Method.=—He forms the cheek flaps in triangular form, including all of the tissue making up the buccal cavity. The outer or cheek incision is made through all of the tissue and extends to a point corresponding to a point a given distance beyond the angle of the mouth. The inner incision is made from a point just below the angle of the ala downward and through the thickness of the lip. A third incision unites the angle of the mouth with the outer incision. Both cheek flaps are made alike, each remaining attached along all of the remains of the old nose. They are now raised upward and inward, with their mucosa facing outward, and united along the median line. The raw cheek borders are now brought forward and held in place by suturing them at either side to the remaining rectangular flap of the upper lip. The formation of the subseptum is left for a second sitting. This method is not only too extensive, but too disfiguring to make its employment practicable. The mucous membrane would, of course, in time take on the function and appearance of skin, but the shape of the mouth never assumes a normal form, especially since there is quite a loss of the vermilion border at either side which is raised upward with the cheek flaps to assist in forming the base of the nose. =Maisonneuve Method.=—Where there is more or less occlusion of the nares and yet an integumentary covering corresponding to the nose, as it might rarely be in congenital cases, Maisonneuve utilizes the sliding flap method to overcome the abnormality. In the case presented, the nasal orifices were hardly three sixty-fourths of an inch in diameter and about one inch apart. The correction was accomplished as follows, and shown in Fig. 345: An incision was made transversely outward from each nostril, then two converging incisions were made from both nares downward, meeting at the vermilion border of the lip in the form of a V, which were made to include the whole thickness of the lip. This flap was brought upward to form the subseptum. The skin to form the nasal lobule was now slid forward from either end of the incision and the subseptum sutured in place. Rubber tubes were employed to keep the nares distended and permit of the wings of the nose to form. The defect in the upper lip was brought together as in a median harelip operation, the parts appearing after operation as illustrated in Fig. 346. [Illustration: FIG. 345. FIG. 346. MAISONNEUVE METHOD.] _The Italian Method_ In this classification of total rhinoplasty the skin flap is taken from another part of the body and not from the face. The integument of the arm is usually employed, the pedicle remaining intact until the flap has healed into place. The method has been accredited to the Italian author-surgeon Tagliacozzi, but it was practiced long before his time; yet he was the first to fully describe the steps of the successful operation. It has been referred to quite fully under skin grafting.