This condition, in which a fold of skin stretches across from the inner end of the brow to the side of the nose covering the inner canthus, is met with principally in children. It usually disappears later in life. It may remain, however, owing to nondevelopment of the nasal bridge and is often met with in the colored races. =Bull Method.=—This defect may be corrected by the excision of an elliptical piece of skin from the anterior aspect of the bridge of the nose, and sewing the wound together with interrupted fine silk sutures, as shown in Figs. 106 and 107. [Illustration: FIG. 106. FIG. 107. BULL METHOD.] =Paraffin Injection.=—As the above operation leaves a linear scar on the anterior nasal line, the author has found it much better to correct the defect by building up the nasal bridge, or the entire anterior nasal line by the subcutaneous injection of one of the paraffin compounds, thus overcoming both the epicanthus and the nasal deformity. In fourteen cases, two Japanese and the rest negroes, the author has obtained excellent and permanent results. The process herein referred to was first suggested in a general way by Gersuny, and has been extensively and successfully utilized in many ways, especially in this country. A special chapter is given to the method elsewhere. Following the injection of the substance employed there is slight swelling for a few days, which may or may not involve the eyelids. This disappears about the second or third day. The injected material becomes organized in two or three weeks’ time and gives no further trouble to the patient. If the patient complains of a dull pain or soreness in the area thus operated upon, the application of cold extract of hamamelis is to be applied on little squares of sterilized gauze, which usually relieves the discomfort in a few hours. CANTHOPLASTY Canthoplasty involves the lengthening of the palpebral fissure at the external canthus. The canthus is divided outward to the extent designed with a pair of angular scissors, probe pointed (Fig. 108), and to the extent as shown in Fig. 109. [Illustration: FIG. 108.—PROBE-POINTED ANGULAR SCISSORS.] The contiguous ocular conjunctiva is dissected (Fig. 110) up and attached to the newly made skin margin with silk sutures to prevent its reunion, one suture uniting the angle of the wound with the raised tip of conjunctiva (Fig. 111). The sutures are allowed to remain about five days. Traction with the fingers should be made several times each day to thoroughly separate the wound and to prevent the contraction of the conjunctival triangle, which would offset entirely the object of the operation. As a rule the fine silk sutures heal out of the mucodermal margins owing to the softening of the tissue through the increased lachrymal secretion caused by the irritation of their presence and the resultant reaction following the operation. [Illustration: FIG. 109. FIG. 110. FIG. 111. EXTERNAL CANTHOPLASTY.]