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Objective To investigate the operation design of the expansion at the first stage.Methods Over 20-year clinic experiences in our department were reviewed.Results The location of the expanders at the first stage were determined according to the reverse design of skin flap to prevent its translocation.In the determination of the expander volume, the defective area as well as the retraction area after the expansion should be considered so that scars might be small with sufficient skin tissue after operation.The thorough intraoperative hemostasis was very necessary.We believe that the chronic expansion is consistent with the growth of cells in tissues, and the acute expansion should not be used.Conclusion The ideal results of the second stage operation can be gained by attaching great importance to the operation design of the expansion in the first stage and the operation details.