The skin within this area is now dissected up quickly. There will be more or less bleeding from the post-auricular vessels, which can easily be controlled by sponge pressure, or with one or two artery forceps of the mosquito-bill pattern. The wound should be large enough to overcorrect the fault, as the ear springs out more or less when healed. Sutures are now introduced. When necessary one or two catgut sutures are taken through the concha, not going through the anterior skin, however, and the deeper tissue back of the ear and tied. These hold the cartilage in place. [Illustration: FIG. 139.—AUTHOR’S METHOD. FIG. 140.—CARTILAGE TO BE REMOVED. (Author’s method.)] For the coaptation of the skin the continuous suture is to be preferred, but when the cartilage suture is employed it will be found impracticable, owing to the close position of the ear to the head. In that event interrupted sutures must be placed, as shown in the Monks operation, and tied after the cartilage has been fixed as described. Where it is deemed necessary to fix the cartilage in this way, the author advises to remove an elongated elliptical piece of the concha, as shown in Fig. 140. This is neatly done by outlining the section with the scalpel, and excising it with the aid of a fine pair of scissors, half rounded; the operator holding the index finger of the left hand in the depression of the concha anteriorly as a guide to avoid injuring the skin. After the elliptical exsection a linear incision with the scissors may be made both superiorly and inferiorly to further mobilize the springy shell of the ear, which will then be found to fall easily into place. The bleeding in the latter method is more severe, since the posterior auricular arteries and the auricular branch of the occipital have to be severed, yet ligation is rarely necessary. The interrupted suture may now be applied, varying the site of puncture as below or above its fellow puncture, as made necessary by the droop of the ear, with the object of shifting it into a normal position; or in other words, by raising or lowering it upon tightening the sutures. The continuous suture is to be preferred, however, when the cartilage has been removed as described, since the ear has now become quite mobile and is easily placed in position. When the removal of these sutures, which should be of Nos. 5 or 6 twisted silk, is considered, one can comprehend the advisability of this form of wound closure. The ear will now appear to lie quite close to the head, compared with the original position, as shown in Figs. 141 and 142. The patient is now turned so as to present the other ear, a pad of gauze and absorbent cotton being placed under the ear operated on for comfort’s sake. The second ear is operated as was the first, the operator having taken note of the form and size of the incision of the ear just finished.