=Monk’s Method.=—This author made a small incision through the skin just posterior to the inferior edge of the lobule, as in Fig. 469_a_. Then with a dull instrument, introduced through the opening, he detached the connecting tissue that binds the skin along the anterior dorsum as far as the root of the nose, giving more or less width to this freed area about the nasal bones. A dull-pointed scissors is introduced through the sublobular opening, and the bones and cartilage are reduced until the desired nasal line has been attained. The method of procedure is shown in Fig. 469_b_. [Illustration: FIG. 469_a._ FIG. 469_b._ MONK’S METHOD.] The wound is cleansed of all spiculæ of bone or bits of cartilage and the skin opening is closed by suture. Healing takes place with more or less ecchymosis in about six days. The difficulty the author finds with this method is that it is practically impossible to do good work with the scissors in this position. The use of an electric drill has been advocated to do away with the scissors, but it is a dangerous instrument and requires great skill for its manipulation and reduces the bone particles to such fine fragments that much of it is left in the wound, which may induce sepsis or cause unevenness of the skin surface until later absorbed or removed. The same fault is observed with cartilage, which it grinds into pulpy pieces and for which it should never be used. =Anterior Median Incision.=—This, perhaps the oldest method, has been extensively employed. The incision is made down the median line of the dorsum of the nose, beginning above the deformity, and ending slightly below the inferior bone line, as shown in Fig. 470. The skin is incised obliquely. An assistant separates the wounds with hook tenaculi, exposing the osseous bridge, as in Fig. 471. [Illustration: FIG. 470. FIG. 471. FIG. 472. MEDIAN NASAL INCISION.] The author advocates dividing the periosteum and dissecting it well back to either side of the bony elevation. By bringing it back over the denuded surface after the chiseling has been done, it aids materially in establishing a smooth surface and hastens the bone repair. The periosteum being held aside, the straight chisel and mallet are used to reduce the bone. The operator may proceed to do this from above down or _vice versa_, according to the formation and position of the protuberance. The redundant cartilage is removed with the knife from above downward, cutting from side to side. Usually the operator does not remove enough of the cartilage and a new angulation of the nose appears after the swelling has disappeared, necessitating a second operation. The wound is closed as shown in Fig. 472. =Lateral Incision.=—The incision in this case is made slightly posterior to the beginning of the lateral border, as shown in Fig. 473. The skin is held back, as shown in Fig. 474, and the same mode of procedure is followed as that just given. [Illustration: FIG. 473. FIG. 474.