LATERAL NASAL INCISION (Author’s method).] The operator will have some difficulty to reach the opposite anterior border of bone elevation, especially if the incision has not been made long enough. This should be done. At no time should the assistant employ too much force in retracting the anterior flap to better expose the field of operation; it is certain to cause gangrene of the skin. To overcome a long scar line, and to facilitate the cutting away of the bone, the author had a special set of chisels made with curved cutting blades, one angular and the other straight-edged. There are two each for working from the right and left sides. The striking point lies midway between the blade and the end of the handle. They are shown in Figs. 475 and 476. [Illustration: FIG. 475. FIG. 476. AUTHOR’S CHISEL SET.] To the set the author has added a suitable metal mallet, an instrument very hard to obtain for osteoplastic operating. All the mallets obtainable are too large and heavy for delicate work (see Fig. 477). [Illustration: FIG. 477.—AUTHOR’S METAL MALLET.] After the bone is reduced to the proper level, the cartilage is cut away as before described, and the wound is sutured. The resultant scar is much better than when made in the median line, and is not so noticeable in this position. This operation gives the best results of all external methods employed for this purpose. CORRECTION OF ELEVATED LOBULE (Retroussé Nose) This condition is frequently a deformity. The base of the nose is tilted upward, unduly exposing the nares. The author prefers to bring the lobule down by excision of the anterior third of the subseptum in preference to submucous dissection of the cartilaginous tissue, causing the deformity. [Illustration: FIG. 478. FIG. 479. AUTHOR’S METHOD.] With an angular scissors introduced through the nares, a triangular section of the septum is removed, as shown in Fig. 478. The apex of the triangle should be placed well up into the septum to break the elasticity of its structure, the base of the triangle being sufficiently wide to somewhat overcorrect the deformity. Such noses are usually narrow at the lobule, and no interference with the lower lateral cartilages is called for. The septal mucoid and the subseptal skin wounds are brought together by suture, as shown in Fig. 479, leaving only a slight transverse linear scar on the subseptum. CORRECTION OF BULBOUS LOBULE Roe corrects this deformity by making an incision, either vertically or horizontally, in the mucosa in one or both nares, through which he introduces the blades of a fine curved scissors, with which sufficient redundant tissue is removed to bring the lobule down into the desired contour. The mucosa should be sutured to facilitate rapid cicatrization. The operation should be overdone to get the desired result.