_Case IV._—Mr. M. B., aged twenty-eight; operatic baritone. Presented himself for operation June 4, 1906. Photograph shown in Fig. 490. Uneventful recovery in fifteen days, when photograph in Fig. 491 was made; angular nose operated upon (at this time discharged; recovery complete). [Illustration: FIG. 490. FIG. 491. AUTHOR’S CASE.] _Case V._—Miss L. W., aged twenty-seven. Presented herself for operation and cast (Fig. 492) made August 4, 1906. Uneventful recovery in ten days. Cast of result made August 18, 1906 (see Fig. 493). In each of these cases the patient was discharged highly satisfied and well pleased with the result of the operation, although in Case V the patient was requested to return in about one month for an operation to reduce the width of the wings of the nose, which was not attempted at the first sitting, but could have been with little difficulty by beginning the primary incision at _E_, Fig. 483, higher up, and cutting out a triangular section on either side of the flap _A_, the apex of each triangle being at point _E_, and the base along the line _D_. The wounds are sutured along the dorsum of the nose with No. 1 twisted silk, after exsecting much of the lower lateral cartilages of the wings, as can easily be reached in the triangular point formed by the raw dorsal border and the inferior edge (_F_). The latter method, however, would be likely to leave a slight cicatricial line on either side of the nose. This could be much overcome by making the incision from point _E_ to _B_ obliquely to the plane of the skin, likewise the posterior sides of the triangles mentioned, just as the incisions at _B_, and across the columna at _C_, are made. Recovery should be complete in five days. [Illustration: FIG. 492. FIG. 493. AUTHOR’S CASE.] DEFICIENCY OF NASAL LOBULE Where there is a lack of lobular prominence it may be enlarged and brought forward by a subcutaneous prothesis if the skin is flexible enough to permit of injection, as has heretofore been described. If this cannot be done, the following operation may be employed to advance the point of the nose, and reduce the width at its base so commonly observed with these cases. =Gensoul Method.=—A deep incision is made from the floor of each nostril downward and backward, meeting at a point just below the union of the subseptum with the upper lip, as in Fig. 494. The deeper tissues are loosened from their attachments to the bone until the subseptum at its base, including the triangular appendage thus made, is freely movable. The lobule is now drawn forward to its required prominence and the parts are sutured Y fashion, as in Fig. 495. If the subseptum be too wide, an elliptical section is removed, including the cartilage, sufficient to give it the desired thickness when brought together, as illustrated. The lips of the wound are brought together as shown. [Illustration: FIG. 494. FIG. 495. GENSOUL METHOD.] CORRECTION OF WIDENED BASE OF NOSE