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Page 10 of 14 Brawley et al. Plast Aesthet Res 2022;9:6 https://dx.doi.org/10.20517/2347-9264.2021.107

Figure 11. O-to-Z local flap in the temporal region. Flap limbs were designed with respect to the hairline, and additional camouflage can
be used after healing is complete.

Figure 12. O-to-Z local flap in the temporal region with centrally located split-thickness skin graft for closure of the defect. This
demonstrates that the best aesthetic result may be achieved by a combination of techniques, mitigating the notion that complete flap
closure must be achieved.

structure after approximately 11 days [53,54] . Expansion intervals should be approximately every 5-7 days for
the scalp, and while additive volumes vary, they are generally around 10% of the volume goal for each
session [53,54] . Desired expansion duration can take weeks to months based on surgeon preference.
Rectangular base expanders are reported to give the largest tissue gains . Several methods have been
[55]
proposed in choosing the size of the expander based on the size of the defect for adequate coverage. These
formulas vary from selecting an expander with a base twice the size of the defect to more complex
[53]
algorithms . Others have simply proposed using the largest expander possible to minimize tissue recoil
[56]
and eventual closure tension .
[57]