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The significant progress in cosmetic epicanthoplasty from 1959 to 2019 was reviewed in this article. The causes and pathogenesis of congenital epicanthus, the classification and grading of various epicanthus, the development and evolution of epicanthoplasty method were summarized emphatically. Meanwhile, the author presents his predictions for the future development and some related issues in this field.
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Epicanthus is a skin fold located in front of the inner canthus. Due to the complexity of the anatomic structure, there are some complications such as insufficient correction, recurrence and obvious scar. To improve the inner canthus shape thoroughly, the epicanthus anatomy is explored. This paper has listed a brief overview of the anatomical research progress of epicanthus and surgical measures method, respectively, in the hope that this review would provide instructive reference for its surgical options.
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Objective: To introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness.
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Objective To study the morphological changes of external eyes before and after epicanthoplasty combined with blepharoplasty and to explore a simple and efficient method to correct epicanthus. Methods A total of 120 eyes in 60 patients were operated on with the inverted L-sharp epicanthoplasty combined with double-eyelid blepharoplasty and the follow-up began 2 months after the surgery. The height and physiognomic length of the eyelid and the length and angle of the eyelash were measured and compared with preoperative meansurements, as well as the distance of the inner canthus. The ratios between the inner-canthus distance and the physiognomic eyelid breadth and the diameter of eyebrow and eye were also described. Results The contours of the eyelid fissure and the double-eyelid were natural and the surgical scare was seen unconspicuous 3 months after the operation. Changes in the palpebral fissure , the angel and length of the exposed eyelash were all significantly different by paired-sample t test (P < 0.01). The vertical and horizontal lines through the entocanthion and the vertical line through the gnomic ectocanthion combined with the horizontal line through the brow ridge formed a square structure. Conclusions This inverted L-shape epicanthoplasty combined with blepharoplasty may be effective in reconstructing the contours of the entocanthions as well as the shape of the double eyelids. It can also achieve better cosmetic effects in the proportional relation between the eyes and eyebrows. Therefore, it deserves clinical promotion.
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Objective To evaluate the clinical effect of the individualized treatment of congential entropion.Methods Totally 150 patients (285 eyes) with congenital entropion were analyzed,the individualized procedures were performed,including the simple incision and suture surgery for simple congenital entropion,removing the redundant skin of lower eyelid for congenital entropion with redundant skin of lower eyelid but without epicanthus,the correction of entropion combined withY-V epicanthoplasty for congenital entropion with epicanthus and the recession of lower eyelid retractor for congenital entropion with lower eyelid retraction.The clinical effect,the percentage of cure and the complication of these cases were evaluated.Results The excellent results were achieved and no relapse or complications occurred in all cases.The total cure rate was 98.6％ (281 of 285 eyes).The cure rate of simple congenital entropion was 92.0％ (23 of 25 eyes).The cure rate of congenital entropion with redundant skin of lower eyelid was 100％ (41 of 41 eyes).The cure rate of congenital halflength entropion accompanied by epicanthus was 99.4 ％ (179/180 eyes).The cure rate of congenital entropion associated with lower eyelid retraction was 97.4％ (38 of 39 eyes).Conclusions Individualized operations not only have well curative effect for various congenital entropions,but recurrence rate and complications have been reduced.
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BACKGROUND: Asian Aesthetic Oculoplastic Surgery is a fast-growing field, both within the United States and abroad. With growing interest, there have also been multiple terminologies used for the same concepts. This has created redundant and confusing language - prone to errors in patient-physician communication. In addition, there has been an upsurge of various techniques or variations to existing techniques that has created unnecessary confusion among plastic surgeons. The objective of this article is to provide organization and simplification to the terminology and to the techniques used in what some broadly refer to as "Asian Blepharoplasty" or perhaps more correctly termed Asian Aesthetic Oculoplastic Surgery. METHODS: Unified terminology, aesthetic goal and detailed operative technique of commonly conducted Asian blepharoplasty were suggested by experienced oculoplastic surgeons. RESULTS: The main procedures of Asian Aesthetic Oculoplastic Surgery including supratarsal crease surgery and medial epicanthoplasty were presented with figure and video in this paper. We also have provided author's preferred selection of the major techniques with evaluation of its advantages and disadvantages. CONCLUSIONS: The most important element in patient satisfaction is clear communication of surgical expectations. Then, proper selection of the most suitable pre-operative design, type of surgery performed, and specific crease configuration based on the individual's anatomic and physiological characteristics can be achieved.
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Humans , Asian People , Blepharoplasty , Eyelids , Patient Satisfaction , United StatesABSTRACT
Objective To explore an operative method which can adequately enlarge the inner canthus with inconspicuous scar and perfect shape based on the transverse incision for epicanthus correction,and to evaluate the short-term results and long-term effects comprehensively.Methods The surface projection of tears port medial point was designed as a new inner canthal point,the full thickness skin from new inner canthal point was cut to the free edge of epicanthus,and an outward prolonged incision was made along the lower eyelid edge,separating the subcutanous dissociation or cutting off part of displaced orbicularis,so to relieve the skin tension of inner canthal and reset skin,suturing the new inner canthal point and lower eyelid edge.Results 120 cases were followed up for more than one year,the complication rate at different postoperative time points and patient satisfactory rate one year after operation were compared.12 cases had mild scar formation,from six months to one year after operation,the scar gradually became softened and then inconspicuous.22 cases had a little skin fold at the inner canthal in postoperational one month.2 cases were unsatisfied with the shape of inner canthal,Others were satisfied with therapeutic efficacy,the correction was sufficient with inconspicuous scar and 1ess recrudescence.Conclusions Epicanthus correction by subciliary incision epicanthoplasty is a simple and effective method and suitable for all types of epicanthic fold,and it has the advantages of sufficient enlarged inner canthus,inconspicuous scar and 1ess recrudescence.
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Objective To explore the methodology of suturing the upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap to the levator aponeurosis,simulating the mechanism of fibers from the levator aponeurosis to the dermis in natural double-eyelid in blepharoplasty.Methods Pretarsal orbicularis myocutaneous flap was harvested.Dissection between the orbital septum and the levator aponeurosis was performed originating from the upper margin of the tarsi until to the levator muscle.The upper margin of the orbicularis muscle in pretarsal orbicularis myocutaneous flap was sutured to the levator aponeurosis.The lower skin margin to the orbital septum to the upper skin margin was sutured interruptedly.Patients with medial epicanthus were performed epicanthoplasty at the same time.Results 136 eyes in 68 patients were performed with double-eyelid blepharoplasty using this method.62 patients were followed-up for 1 month and 53 patients were followed-up for 3 months.They all reported satisfactory aesthetic results.Conclusions Double-eyelid blepharoplasty using this method accords with the physiological mechanism in natural double-eyelid.Postoperative double-eyelid is natural with little tumefaction.This method can avoid double-eyelid fold retraction and multi-fold occurrence.
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ObjectiveTo assess the effect of modified minimally-invasive transverse-vertical epicanthoplasty in double-eyelid plastic with three points at the same period.Methods87 cases with mild or moderate epicanthus and oriental eyelid were involved in our research.Epicanthoplasty was performed based on the principle of transversevertical plasty.The curvilinear incision of epicanthoplasty was made between the desired point of the new medial canthus and the lower lacrimal point,the malpositioned orbicularis oculi muscle excised after skin undermining,the superficial head of the medial canthal tendon plicated or anchored to the lateral nasal aponeurosis and the incision closed after skin redraping.Double-eyelid plastic with three points was performed as usual,however,the incision of eyelid plastic was connected with the incision of epicanthoplasty by skin tunnel in which a strip of orbicularis oculi muscle was excised.Results87 cases were followed-up for 3 to 24 months.The cosmetic results of the new medial canthi were satisfactory with new figure and inconspicuous scar.The contours of the double eyelids were natural.No incisional scar presented between the medial canthi and the upper eyelids.No recurrence of epicanthus was observed.ConclusionThe modified mini-incisional transverse-vertical epicanthoplasty together with double-eyelid plastic with three points is a simple and effective feasible surgical approach for correction of epicanthus and oriental eyelid.
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Objective To explore the techniques of epicanthoplasty with concurrent double eyelid plasty. Methods Epicanthoplasty was performed based on the principle of transverse-vertical plasty. The curvilinear incision of epicanthoplasty was made from the desired point of the new medial canthus to the point 1 mm below the lower lacrimal point, the malpositioned orbicularis oculi muscle excised after skin undermining, the superficial head of the medial canthal tendon plicated or anchored to the lateral nasal aponeurosis and the incision closed after skin redraping. Double eyelid plasty was performed as usual, however, the incision of eyelidplasty was connected with the incision of epicanthoplasty by skin tunnel in which a strip of orbicularis oculi muscle was excised. Results From Oct. 2006 to Feb. 2009, 189 cases were treated. The follow-up period ranged from 3 to 24 months. The cosmetic results of the medial canthi were satisfactory with inconspicuous scar and no recurrence. The contours of the double eyelids were natural. No incisional scar presented between the medial canthi and the upper eyelids. Conclusion The modified transverse-vertical epicanthoplasty with concurrent double eyelidplasty is a simple and reliable surgical approach for correction of epicanthus and creation of supratarsal fold.
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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.
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PURPOSE: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. METHODS: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. RESULTS: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. CONCLUSION: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.
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Female , Humans , Young Adult , Asian People , Blepharoplasty , Edema , Follow-Up Studies , Lacrimal Apparatus Diseases , Membranes , Needles , Recurrence , SkinABSTRACT
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.
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Objective To investigate a new method in correction of epicanthus.Methods Asymmetrical Z-plasty was used in correcting epicanthus and lengthening palpebral fissure in 42 cases with 84 eyes.It could be combined with double-eyelid-blepharoplasty to create beautiful eyes.Results All 42 cases with 84 eyes had satisfactory outcome after half a year to 2 years follow-up.The epicanthus scar was conspicuous in the first 6 weeks and it subsided gradually.In the three cases.the hypertrophic scar occurred in the epicanthus,but it softened and became inconspieuous 6 mouths after operation.Conclusion Asymmetrical Z-plasty is a new and reliable method for correction of epicanthus with inconspicuous scar and little chance of recurrence that can be widely used.
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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.
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Objective To explore a simple and effective epicanthoplasty.Methods A total of 65 cases were corrected by incising the epicanthus levelly,extending the incision along the lower palpebral margin,separating the skin about 1 cm×1 cm scope below incision,cutting off part of the orbicularis and epicanthus ligament,fixing epicanthus angle to nasal aponeurosis,and suturing the incision without tension.Results All the cases corrected by the transverse-one's procedure were followup one month to one year,and satisfactory results obtained.Conclusion This method is a simple and effective epicanthoplasty with less tissue damage and good appearance.
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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.
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Humans , Cicatrix , Eyelids , Sterilization, TubalABSTRACT
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.
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Humans , Asian People , Cicatrix , Eyelashes , SkinABSTRACT
The medical epicanthal folds on eyelids is one of the unique features of Asians. Epicanthoplasty enhances the aesthetic results of eyelid surgery by lengthening the palpebral fissure and producing the image of a larger, more open eye. Many authors described surgical procedures for correction of epicanthal folds. But most of them leave additional scars. We used to use Hiraga's method for correcting the epicanthal folds. Hiraga's epicanthoplasty is simple and practicable method. However, Hiraga's method has the disadvantage of making vertical scar on the nasal side of the lower eyelid. To overcome this disadvantage, we transposed the incision line to be paralleled with the margin of lower eyelid. We presented here a simple epicanthoplasty with minimal scar based on modified Hiraga's method with 24 cases performed during the past 3 years. A double fold operation and ptosis correction was performed along with epicanthoplasty in 18 cases and a epicanthoplasty without a double fold operation was performed in the remaining 6 cases. The follow-up period ranged from six months to two years. The results, with the exception of one case of hypertrophic scarring and one case of undercorrection, were all satisfactory. The advantages of our procedure are simplicity in design and the minimal scarring produced in the medial canthal area compared with a Hiraga's method or complex W-plasty, Z-plasty, or half Z-plasty requiring multiple incisions and often creating unsightly scarring on the medial side of lower lid. This method can be one of the effective procedures for correcting the Asian epicanthal fold because of avoiding potential visible scar on the lower lid.
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Humans , Asian People , Cicatrix , Cicatrix, Hypertrophic , Eyelids , Follow-Up StudiesABSTRACT
Epicanthoplasty with or without double-eyelid operation is one of the most commonly performed aesthetic procedure in Korea. Although many techniques have been described for the elimination of epicanthal folds, scarring and complexity in design are still barriers for surgeons to overcome. Epicanthoplasty using Hiraga's method was used to minimize these problems. From September of 1996 to July of 2002, the authors performed epicanthoplasty using Hiraga's method on the eyelids of 117 Asian patients to correct epicanthal folds. Results were satisfactory in almost all patients, with no significant complications. Scarring was acceptable. Mean reduction of intercanthal distance was 3.7 mm and mean operation time was within 10 minutes. Hiraga's method is most effective in patients with mild to moderate epicanthal fold. The advantages of this procedure are simplicity in design and short operation time. Most of all, it's technically simple and easy to perform.