The lateral triangular flaps are dissected up so that they can be readily slid forward toward the median line. Their inner freshened margins are sutured to the raw edge of the septum just made, and to themselves. The objection here is that there is a liability of considerable contraction of these lateral flaps, with a tendency to fall in and drag with them the new septum; and again, in total restorations, the upper third of the nose is only partially covered, and necessitates later upbuilding. The author finds difficulty in making the four margins thus brought together unite evenly throughout, and that a vertical contraction is caused by the cicatrization of the median marginal wound. [Illustration: FIG. 367.—First Step. FIG. 368.—Disposition of frontal flaps. SZYMANOWSKI METHOD.] =Goris Method.=—The operation is performed as follows, having given very good results, according to the author: I. The frontal flap is divided lengthwise so that its raw surfaces face each other. The resulting fold, representing the bridge of the nose, is held in place by catgut suture. II. The skin to make the wings of the nose is folded in, as in the Langenbeck method. III. A flap, half the thickness of the upper lip is brought up to form the new subseptum. IV. Dissection and turning down the triangular flap of skin which surmounts the orifices of the old nose, and making it serve to line the lower part of the frontal flap. V. Suturing the frontal flap thus modeled into two grooves made into the margins of the old nose along both sides to its base. ORGANIC SUPPORT OF NASAL FLAPS It soon became evident to the rhinoplastic surgeon that without some support to the flap or flaps used for the construction of the new nose all of the preceding methods, as far as æsthetic results were concerned, were useless. Truly, the deformity lost its hideous appearance to a great extent, but the general results obtained hardly warranted a patient to undergo restorative operations of the nose. In fact, many surgeons advised against total rhinoplasty when practically all of the old nose was lost. Langenbeck says “that total rhinoplasty, or even operation as to repair partial loss of the nose by the use of soft flaps, should not be undertaken. It is better to rely upon some prothesis.” All that could be expected of utilizing the flap and making it heal into place had been accomplished up to about the year 1879. Thereafter many surgeons proceeded to evolve and use some kind of intranasal prothesis made of various inorganic materials. It may be stated, however, that Rousset in 1828 wrote: “Perhaps some day surgeons will give whatever shape they desire to the reconstructed nose. Then a frame of gold or silver, cleverly shaped and solidly fixed in the nose, will give the patient, at his own option, a Roman or Carthaginian nose, and to the ladies a choice of a roguish type, and to our Sultans a nose a la Roxelane.”