Not infrequently the extreme convexity of the lower lateral cartilage must be overcome by either removal submucously or by excision of the cartilage itself, employing an elliptical incision in the mucosa for the purpose. The alæ are kept in position after such ablation by compress dressings or by a suture made transversely through both wings of the nose and the septum, and tied over a quill or cork support placed externally upon the skin at either side of the nose. This is removed about the sixth day. Sheet lead or a splint of aluminum of proper thickness and covered with gauze may also be used to retain the parts during cicatrization. ANGULAR EXCISION TO CORRECT LOBULE When the lobule is unduly broad at its base and is more or less concave above the rim of the alæ, it can be reduced by removing a diamond-shaped piece of tissue at either side of the subseptum. The bases of the two triangles making up the diamond at its widest area meet at the anterior rim of the nostrils, extending with their apices upward and backward, as shown in Fig. 480. If there be a prominence of the cartilaginous structure of the lobule, this may be removed subcutaneously after the two ablations have been made. [Illustration: FIG. 480. FIG. 481. AUTHOR’S METHOD.] Before suturing the wounds, it is advisable to free the skin of the inferior lobule to overcome tension. The sutures are applied as in Fig. 481. None are used to unite the mucosa unless the interior wounds are large enough to permit of their use. CORRECTION OF MALFORMATIONS ABOUT THE NASAL LOBULE The operations herein described apply particularly to the correction or reduction of an overprominent nasal tip due to an excessive growth of congenital malformation of that part of the nose, giving the organ undue prominence and a hooklike appearance, usually associated with a narrow, sharply upward inclined upper lip. =Pozzi Method.=—The same operation, on a larger scale, can be readily employed for the correction of hyperplasia nasi and rhinophyma. In the operation of Pozzi (_Bulletin et mémoire de Société de chirurgie_, 1897, p. 729) an elliptical section of skin and cartilage are removed from the lobule with its widest part corresponding to the point of the nose; the cicatrices occasioned thereby are practically as bad, if not worse, than the unscarred overprominent nose, while the submucous procedure of Roe (_Medical Record_, July 18, 1891) is not only insufficient in these cases, but, according to my experience, practically useless.