The free end of the flap _A_ is now sutured with No. 4 sterilized twisted silk to the stump of the columna at _B_. Two stitches usually suffice (see Fig. 485). One or two sutures may also be taken across the angles of union of the alæ and the flap _A_. The inferior raw surface of each wing may be found to be too wide, owing to the presence of the thickened cartilage at this point of the wing. The skin and the mucous membrane are then carefully peeled away from the cartilage, and the latter cut away as high as possible, or a gutterlike incision is made along its edges as shown in _C_ (Fig. 485), excising the elongated elliptical piece of tissue which includes the cartilage. The raw mucocutaneous edges of the wings are now brought together with a No. 1 twisted silk continuous suture, completing the operation. An antiseptic powder is dusted over the parts operated on, and small gauze dressings are applied with the aid of strips of silk isinglass plaster. A small tampon of cotton, well dusted over with an antiseptic powder, is placed into each nostril. The dressings are changed the second day, when the resultant swelling will have practically subsided. The sutures in the columna are removed the fourth day preferably, and those of the wings about the sixth day. Complete cicatrization follows in about ten days, when the patient can be discharged. The following cases are given to show the types of cases thus far operated upon and to illustrate the results obtained: [Illustration: FIG. 486. FIG. 487. AUTHOR’S CASE.] _Case I._—Mr. R., aged thirty-two; foreman mechanic. Had been operated upon for angular nose, also at point of nose by Dr. S. Presented himself for operation October 19, 1904, when cast was made (see Fig. 486). Bromides given during recovery. Patient had been subject to fits of depression on account of his nose for over a year. Wounds healed in ten days, when second cast was made (Fig. 487). Complete recovery. _Case II._—Miss B. P., aged twenty-two; actress. Patient presented herself for operation March 22, 1905. A long, irregular depressed cicatrix showing at point of nose, the result of an attempt to reduce tip of nose by an elliptical extirpation of the lobule (Dr. N.). No cast was made of the case at the time, so that a second cast showing the result would be of no use. Recovery complete in twelve days. Patient returned to her profession three weeks later much pleased with the result. [Illustration: FIG. 488. FIG. 489. AUTHOR’S CASE.] _Case III._—Mr. L. L., aged twenty-eight; broker. Presented himself, at the advice of Dr. T., for operation May 2, 1905. Cast of cast made and shown in Fig. 488. Uneventful recovery in twelve days, when case Fig. 489 was made.