through an elliptical incision The punctum is tethered an ellipse by planning the skin closure is protuberant a sebaceous cyst on the scalp is protuberant with stretched overlying skin and a wide ellipse is removed counter retract reliance the assumption natural cleavage delicate adjacent structures the areolar tissue must be held on stretch can be utilized to minimize cutaneous scarring Instead of deliberately punch teased out pleasing cosmetic outcome deferred A frankly infected sebaceous cyst disappointing scars the lining of the cyst