Total rhinoplasty presents several problems, the most important of which is that of obtaining a lining for the nose. The lining of the ala and the formation of a columella is best accomplished by the method of Nélaton1 by turning the distal end of the forehead flap on itself. The lining of the upper part of the nose is usually obtained by turning in flaps from the margin of the opening. I have used a free full-thickness skin graft for this purpose with satisfactory results.
It may be necessary to employ rhinoplasty in cases of trauma, and of benign or malignant disease. Following removal of a squamous-cell epithelioma the reconstruction should be delayed for from eight to twelve months, depending on the grade or activity of the lesion. If the reconstruction is attempted too early undetected malignant growth may occur underneath the flap; this is most demoralizing to the