Medial epicanthoplasty by using palpebral margin incision / 中华医学美学美容杂志

Objective To introduce a new method for correction of epicanthal folds, which could avoid obvious scar in medial canthus. Methods First, through upper and lower palpebral margin incisions, the connective and orbicularis oculi muscle dense fibers underlying epicanthal folds as well as the superficial head of medial canthal ligament were thoroughly released and excised. After repositioning the medial canthus, the redundant skin tissue was removed and then the incisions closed. Results 122 epicanthoplasties had been performed. Postsurgical scars were invisible in all cases. All patients were satisfied with operation results. No recurrence of epicanthal fold was observed. Conclusions The introduced method has advantages in avoiding scar formation and is an especially suitable approach for epicanthoplasty in Asian patients.

Modified Y-V epicanthoplasty by raising medial canthus / 中华医学美学美容杂志

Objective To explore an epicanthoplasty with good effect and small scar. Methods A V shape incision was designed in medial canthus and the two lines: point A is the top point of medial canthus and point A' is the top point of new medial canthus. The length of line AA' is about 4 to 8 mm according to the medial canthus and th incision is Y shape, and then Y-V epicanthoplasty is raised and enlarged. Results From January 2005 to December 2008, 98 cases were treated with this method to eliminate the medial epicanthal fold of the upper eyelid with simple procedures. Scarring of the medial canthal area had not been a problem with this technique because we designed incisions along the eyelashes and skin-mucosal junctions. By raising the point of new medial canthus to physiological position the angle of medial canthus was enlarged to reveal a lacrimal lake. Conclusion This technique is a simple, easy procedures with no visible scar.

Modified epicanthoplasty combined with same stage small incision blepharoplasty / 中华医学美学美容杂志

Objective To investigate the possibility of performing epicanthoplasty with same stage small incision blepharoplasty. Methods At the same stage of designing small incision blepharo-plasty, modified "Z" plasty without flap transposition was designed. The upper lid incisive line of epi-canthoplasty was bided in the double eyelid fold, while the lower eyelid incision located at the edge of eyelid. Results A series of 56 patients were treated with this method. Satisfactory esthctical result of double eyelid fold and inner canthus shape was achieved. Conclusion This modified method including epicanthoplasty combined with same stage small incision blepharoplasty has the advantages of minimal scar formation, easy to design perform and in accordance with physiology.

Decreasing scar formation with subcilliary incision in medial epicanthoplasty / 中华医学美学美容杂志

Objective To discuss a simple and effective method of medial epicanthoplasty with the subcilliary incision, which can decrease the visible scar. Methods From January of 2007 to De-cember of 2008, 38 patients with epicanthal fold underwent epicanthoplasty using the new method. During the operation a skin incision was subcilliarily made outward from the original medial epican-thus. After elevating the flap and excising the orbicularis oculi muscle beneath the epieanthal fold, the new medial epicanthus was sutured to the designed point. Then subciliary incision was trimmed and sutured. Results Most of the patients obtained satisfactory results. Only one patient complained a-bout visible scarring and none required revision surgery. Scarring was avoided on the noticeable medial canthal region because the only incisions needed were subciliary incisions. Conclusions This method is simple to design and easy to perform. The operative results are effective without visible scars on the medial canthal region.

Epicanthoplasty Using Modified Uchida Method to Shift an Epicanthal Fold in a Superomedial Direction

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.

Periciliary Epicanthoplasty

Visible scar is the most annoying problem in the surgical procedure to eliminate the medial epicanthal fold, which is a predominant feature among the Asian population. Many surgical techniques have been introduced since the early decades of the 20th century, but the scar problem still has been remained unsolved. If all the skin incision lines were located along the muco-cutaneous junctions and just below the eyelashes, resulting scars could be nearly invisible after 3 or 6 months postoperatively. I think periciliary epicanthoplasty will be the appropriate method to realize this concept perfectlly. From January 2002 to August 2006, 427 patients with medial epicanthal folds underwent epicanthoplasty using a periciliary Y-V advancement procedure in my office and most results have been proved scar free and natural. Surgical design of this procedure is very simple and acceptable to any type of epicanthal folds. Based on my own experiences I would like to offer some tip offs in performing this procedure together with surgical techniques and guidelines.

A Case of One Stage Correction of Pterygium Colli and Ptosis with Epicnathal Fold in Pediatric Ullrich-Noonan Syndrome

Ullrich-Noonan syndrome was first recognized as a unique entity in 1963 when Noonan and Ehmke described a series of patients with unusual faces and multiple malformations. These patients proved to have phenotypes of Turner syndrome with normal karyotyes, which is important feature that distinguishes Noonan from Turner syndrome. Typical features are triangular shaped face, hypertelorism, down slanting eyes, ptosis, strabismus, amblyopia, refractive errors, low set ears with thickened helices, high nasal bridge and webbed neck. A 5-year old female was admitted to our center for a surgical intervention of the known webbed neck deformity, ipsilateral upper eyelid ptosis and bilateral epicanthal fold. She had normal karyotye(46, XX) without further abnormality on physical examination. We corrected the webbed neck deformity, ptosis and epicanthal fold simultaneously with satisfactory result.

Surgical Correction for Upper Lid Epiblepharon and Epicanthal Fold in Children

PURPOSE: We evaluated the surgical correction for upper lid epiblepharon and epicanthal fold. METHODS: Epiblepharon repair of the upper lid and epicanthoplasty were performed for patients who had a significant epicanthal fold, by which resultant cilia-cornea touch would be expected of the epiblepharon repair alone. From June, 1998 to February, 2004, 21 patients were operated on and 7 of the patients had Down's syndrome. RESULTS: The mean age of the patients at the time of the surgery was 8.6 years. In all the patients, the epicanthal folds were type 3, according to the Park's classification. Thirteen patients, including Down's syndrome patients, underwent modified Y-V advancement and eight patients underwent root Z-epicanthoplasty. The cilia-cornea touch was relieved in all of the patients except for those with Down's syndrome. Hypertrophic scar was seen in 7 patients with modified Y-V advancement and in 1 patient with root Z-epicanthoplasty until postoperative 3 months. CONCLUSIONS: Epiblepharon repair along with epicanthoplasty was effective in relieving cilia-cornea touch in children with upper lid epiblepharon and significant epicanthal fold. Root Z-epicanthoplasty can be recommended for growing children, considering that it provides moderate degree epicanthal correction and does not leave noticeable scar.

Eyelid Shape of the Chosun Dynasty: Analysis of 101 Portraits

The aim of this study is to elucidate the morphology and preference of the eyelid shape of the Chosun dynasty. One hundred and one portraits of Chosun dynasty were analyzed. Portraits of early(1392-1550), mid(1551-1700), and late (1701-1910) Chosun dynasty were 26, 17 and 58 respectively. The most of the portraits were men of noble birth(86). Others were the portraits of the Kings(4) and Monks(4), Women(4) and patriots(4).The double fold were observed in 20%, among them 65% were outfold. Epicanthal fold were present in 16% Thirty-one% had hooding of the upper eyelid. Sixty nine% had Wrinkles of the lower eyelids. Sixty three had baggy lower eyelid and lower lid ectropion were observed in 6% and 1% respectively. According to the Korean aphorism of the portrait drawing of Chosun dynasty "If one hair is different, the portrait is another man's", the portraits were drawn like a photograph. In this aspect our attempt to light up the eyelid shape of several hundreds years ago when photographs were not available have validity.

Epicanthoplasty with Modified Uchida Method

Epicanthal fold, also referred to a mongolian fold, is a semilunar fold of skin extending from the upper eyelid across the medial canthal area to the margin of the lower eyelid medially. It is present in fetal life in all races but disappears before birth in all but the mongolian races, who retain it as a characteristic features. In northeast asia approximately 60-86% of the population are known to have it. There are four types of epicanthus described by Johnson: epicanthus tarsalis, epicanthus palpebralis, epicanthus supraciliaris and epicanthus inversus. Of these, the epicanthus tarsalis(ET) and epicanthus palpebralis(EP) are most commonly found in the Mongolian. ET arises from the tarsal fold and merges into the skin near the medial canthus. EP arises above the upper tarsus and extends to the inferior orbital rim. The facial features include invisible lacrimal caruncles and narrow palpebral fissures that present a "bug-eyed "appearance in many patients. Visible scarring after removing the epicanthal fold was so commonplace that patient satisfaction was low in many cases. To overcome this, the modified Uchida method is proving to be a most advance procedure with high satisfaction results. I employed the split V-W plasty method, pioneered by Uchida, in 1000 patients over 6 years. The prcedure involves drawing a "V" equal to an isoceles triangle with arms of 3 mm in length from the vertex. The vertex of the "V" is aligned with the horizontal center of the eye and touching the epicanthal fold. After the "V" is drawn, "arm" are extened from its end outwards parallel to the epicanthal folds of the upper and lower lids, thus creating the "W". The length of the arms is determined by the size of the the fold(5-7mm). In cases of ET, the lower arm is slightly shorter (3-5mm) than that of the upper arm of the the resulting "W". Once the "W" is created , this then incised with a 15 scalpel. Thereafter, even tension is applied medially toward and the advancement is made with fine scissors from the apex of the "W" towards to the inner canthus. The new medial canthus is then drawn to the apex of the "W" and sutured with 7-0 black nylon. The overlapping skin at each arm is excised and closed not to make any dog-ear formation.

Metric and Non -metric Characteristics of Korean Eyes Using Satadardized Photographs / 체질인류학회지

The purpose of the present study was focused the anthropometric charateristics of normal Korean eyes, including inclination, height, width, epicanthus and upper eyelid crease. The author measured normal eyes and investigated incidence of epicanthal fold and upper eyelid crease in 774 males and 658 females with photographs. The epicanthus were classified by three types and the upper eyelid crease were classified by four types. The angle of inclination of eyes was larger in females than males and in young ages than old ages. Incidence of the slanting eye over 10 degree was 34.1 % in males and 41.0% in females. Incidence of the epicanthal fold was 57.0%, and there was no difference between males and females. The most common type of the epicanthal fold was type I. Incidence of the upper eyelid crease was 30.9% in males, 47.2% in females. The most common type of the upper eyelid crease was parallel (or floating) type. In conclusion, the anthropometric characteristics of normal Korean or oriental eyes are apart each other and slanting eyes in addition to puffy eyelid, narrow palpebral fissure, presence of epicanthal fold and absence of upper eyelid crease.

Z-Epicanthoplasty Combined with Double Eyelidplasty: Its Indication, Results & Pitfalls

The formation of pretarsal fold without modification of the medial canthal folds may produce eyes with rounder and narrower palpebral fissures. In the last 6 years, the authors performed double eyelidplasty in 16 patients with Oriental eyelids and type III medial epicanthal fold. In 9 patients, simple double eyelidplasty was performed and in 7 patients double eyelidplasty combined with Z-epicanthoplasty were performed. The aesthetic and functional outcomes, and overall patient satisfaction were followed up in 15 patients up to 5 years. In group of double eyelidplasty only, results were equivalent to Good selectively in only 4 patients who had relatively long preoperative palpebral fissure. The epifolds were sustaining in all patients. Remaining patients showed Fair or Poor results. In group of double eyelidplasty combined with Z-epicanthoplasty, all patients showed Good or Excellent results except one who had defective scar maturation. To achieve apparent aesthetic enhancement and beautiful looking eyes with lengthy palpebral fissure in patients with Type III or IV medial canthal epifold, epicanthoplasty should be combined with double eyelidplasty. It achieves apparent aesthetic enhancement by eliminating the medial epicanthal fold and opening the lacrimal lake widely leaving minimal scar and natural supratarsal skin fold line in a single stage operation.