The best results, both as to the primary and secondary wounds, are those obtained with the Italian method, and in extensive cases the use of a combined flap, wherein the lining flap is taken from the nasolabial furrow or just above it. This leaves a linear scar that does not disfigure the face, and assures of better contour than when a single integumentary flap is employed which, as has been so frequently mentioned, is liable to curl inward and contract in an upward direction, adding little to the area of lost tissue. The ideal operations are those which include cartilaginous supports, which may be obtained from about the border of the deformity or from some remote place, as of the ear. The surgeon is hardly justified to use the remaining healthy tissue of the nose, unless the case is such that the secondary wound can be corrected, so as not to add scars to the face. Small defects can be easily corrected by sliding flaps taken from the vicinity of the defect, whether they include cartilage or not, and by granulation or dissection and approximation of the skin, the secondary wound may be entirely closed. It is remarkable how little linear scars show about the nose when the lips of the wounds have been neatly brought together. The author advocates the use of the continuous silk suture for this purpose, since it fulfills both the object of suture and splint and overcomes the corrugating effect, so often found with interrupted sutures; furthermore, a continuous suture is more easily withdrawn, and there is no danger of wounding the skin on removal, and the discomfort to the patient is greatly reduced. From the foregoing descriptions of procedure, the surgeon has been sufficiently familiarized with such steps in rhinoplasty as are usually employed, and it would be a matter of constant repetition to rehearse these same steps for the following operations; therefore the author trusts the illustrations given will be sufficiently lucid to work from. All special features to be observed are given. =Denonvillier Method.=—The secondary wounds made by the two methods here given may be allowed to heal by granulation or be covered with skin grafts, as heretofore described. [Illustration: FIG. 418.—Making of flap. Pedicle anterior. FIG. 419.—Disposition of flap. FIG. 420.—Pedicle posterior. FIG. 421.—Disposition of flap. DENONVILLIER METHOD.] =Mutter Method.=—A skin flap is taken from the cheek and slid forward into the defect as shown. [Illustration: FIG. 422. FIG. 423. MUTTER METHOD.] =Von Langenbeck Method.=—The skin flap is taken from the healthy side of the nose and brought into the defect by sliding. The secondary wound is allowed to heal by granulation. [Illustration: FIG. 424. FIG. 425. VON LANGENBECK METHOD.]