OBJECTIVE Choosing the correct side for Karydakis flap in treatment of pilonidal disease in certain cases. METHODS When the cyst or diseased tissues appear deep into the opposite side it may create some annoying problems, like too thin skin edge, dead space and wound failure. Herein, a simple modification of skin incision marking to over-come this potential problem is described. CONCLUSIONS This simple technical offer could be useful when dealing with sacrococcygeal pilonidal disease in daily surgical practice.