[Illustration: FIG. 359. FIG. 360. THIERSCH METHOD.] =Helferich Method.=—His is an ingenious application of the French method. Both flaps are cut from the cheeks; the lining flap was made from the left and the covering one from the right cheek. The shape of the flaps is shown in Fig. 361. The lining flap is stitched along the freshened margin of the right side of the nose. The flap should be wide enough to give convexity to the nose, as shown in Fig. 362. The covering or right flap, cut much larger, is now slid over this. It should be cut amply large to cover the flap just sutured in place. It is sutured on both sides of the nose to hold it in place, also at the inferior margin. The nose is lightly packed with iodoform gauze. The pedicle of the right flap was cut after two and a half weeks and brought into place across the root of the nose, and sutured in place to give better contour to the part after freshening the skin about the left side of the nose at this point. He does not make a subseptum, but thinks the inferior base of the nose of sufficient size to hide the absence thereof. The subseptum could, however, be readily made from the upper lip, as will be shown later. [Illustration: FIG. 361. FIG. 362. HELFERICH METHOD.] =Sedillot Method.=—This operation is particularly efficacious in giving a splendid subseptum and support of the point of the nose, but does not overcome the falling-in of the whole anterior line, so common with all Indian-flap methods. A flap one centimeter wide and extending downward almost to the vermilion border is cut from the thickness of the upper lip, not including the mucous membrane, however. It is turned upward, as shown in Fig. 363. The frontal flap is fashioned as shown, care being taken to cut a subseptal rectangle of greater length than usual, since it is intended to overlie the raw surface of the flap taken from the lip. It is rotated downward and sutured into place at both sides, and also to the lip flap, to assure of accurate union. A lateral view of the nose as formed in this manner is shown in Fig. 364. The free end of the septal flap is fixed into the superior lobial wound with a harelip pin. The lobial wound is sutured as in ordinary harelip operations. This method is particularly valuable in total rhinoplasties involving the columna and alæ in conjunction with flaps obtained by the Italian method. [Illustration: FIG. 363.—Anterior view. FIG. 364.—Side view. SEDILLOT METHOD.] =Küster-Israel Method.=—A flap was taken from the arm by the Italian method, which was sutured to the remains of the old nose so that its raw surface looked upward, not downward, as in the ordinary case. The flap was made sufficiently large to permit of building the wings and subseptum. After it had healed into place the pedicle was cut, and a frontal flap was cut from the forehead to cover it.