The paramedian scalp reduction with posterior Z-plasty. A technique to minimize the "slot" defect.

BACKGROUND One consistent and undesired sequela resulting from scalp reductions has been the "slot" or "trough" defect, referring to the scar following the final reduction. Attempts to correct this have not been entirely satisfactory. OBJECTIVE To present an approach to minimize the "slot" defect that consists of staged modified paramedian scalp reductions combined with a large posterior Z-plasty during the final reduction. METHODS A paramedian crescent-shaped ellipse was marked onto the patient's scalp parallel and adjacent to the existing fringe hair. Subsequent reductions were performed in a similar manner approximately 2 months apart. The final reduction consisted of mobilization and transposition of the large flaps used in the posterior Z-plasty. RESULTS Patients who underwent the staged modified paramedian reductions combined with a posterior Z-plasty had significant minimization and adequate camouflage of the undesirable "slot." CONCLUSION Combining a large posterior Z-plasty with a paramedian reduction minimizes the slot defect.