Presence and development of strabismus in children with telecanthus, epicanthus and hypertelorism

Purpose: To study the presence and development of strabismus in children with telecanthus, epicanthus, and hypertelorism. Methods: This is a prospective, longitudinal, and observational study. Sixty children aged between 6 months and 18 years with telecanthus, epicanthus, and hypertelorism in isolation or in combination were recruited. A detailed analysis of the history, determination of best corrected visual acuity, complete evaluation of strabismus, and ocular examination were carried out. The presence of telecanthus, epicanthus, and hypertelorism and associated strabismus, if any, was noted. All children were followed up for a minimum and maximum period of 12 and 18 months, respectively, to analyze the strabismus (previously present) and for detection of strabismus in those who did not have. The data were analyzed descriptively with mean and standard deviation. Chi square test and Fishers exact test were used to analyze the data between the groups. A P value less than 0.05 was considered to be statistically significant. Results: Telecanthus was the most common lid feature (55%). At baseline, ten (16.66%) children had strabismus (six: esotropia; four: exotropia). Two (3.33%) children underwent surgery. One child developed exotropia at the third follow?up (18 months). At the end of the study, 11 (18.33%) children had strabismus. No significant association was seen between lid characteristics and the type of strabismus. Conclusion: Children with telecanthus, epicanthus, and hypertelorism in isolation or in combination may or may not have associated strabismus. These features can pose difficulty in strabismus diagnosis, which mandates a careful examination, especially in younger age groups and small?angle strabismus. On the other hand, children without strabismus need longer follow?up to detect the development of strabismus and to initiate further management at the earliest.

Management of congenital lacrimal fistula combined with eyelid cosmetic surgery / 中华医学美学美容杂志

Objective:To investigate the feasibility and availability of one-stage treatment for congenital lacrimal fistula combined with blepharoplasty and epicanthoplasty.Methods:From November 2014 to March 2021, 6 female patients with congenital lacrimal fistula and epicanthus were treated in the 2nd Department of Maxillofacial Plastic Surgery Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, aged 12-32 years (mean 24 years), including 5 unilateral lacrimal fistula and 1 bilateral.Results:During 3 to 40 months (mean 18 months) of follow-up, the ocular appearances were improved notably and the fistulas were removed completely. There was no secondary infection or cyst occurred, and no ectropion, traction or other deformities. The position of canthus was normal and the shape of canthus was good. The scars in the operation area were inconspicuous.Conclusions:Fistulectomy combined with blepharoplasty and epicanthoplasty can excise congenital lacrimal fistula effectively while improving the ocular appearance by this procedure.

Effectiveness of upper eyelid rotation flap via blepharoplasty incision for correction of mild to moderate epicanthus / 中国修复重建外科杂志

Objective: To evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision. Methods: A clinical data of 34 patients with mild and moderate epicanthus (trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed. And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional "Z" plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups ( P>0.05). The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre- and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics. Results: All incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision; and there were scars at inner canthus of control group, with obvious hyperplasia in 6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%, 3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups ( t=0.005, P=0.996; t=0.287, P=0.871). The effectiveness was excellent in 20 cases, good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%; meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%. There was no significant difference between 2 groups ( χ2=0.796, P=0.372). Conclusion: The modified epicanthoplasty by using upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.

Current status and issues of cosmetic epicanthoplasty / 中华整形外科杂志

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.

Improvement of mild epicanthus treated by continuous embedding method / 中华医学美学美容杂志

Objective@#To evaluate the effect of continuous embedding on the improvement of mild epicanthus by studying the change of intercanthal distance and inner canthus angle in patients perioperatively.@*Methods@#In this study, 34 patients with single eyelid and mild epicanthus were analyzed retrospectively. Procedure included small incisions combined with continuous embedding double eyelid surgery. The photo of eyes was taken in the front position preoperatively and postoperatively. Before operation, 3-months, 6 months-after operation, intercanthal distance and inner canthal angle of both eyes were measured by Photoshop CS6. The iris diameter scale was used to measure intercanthal distance.@*Results@#Preoperative intercanthal distance (PRICD) values were 65.96±4.94 (iris diameter scale), 3-month-postoperative intercanthal distance (3POICD) values were 63.43±5.04 (iris diameter scale), and 6-month-postoperative intercanthal distance (6POICD) values were 63.82±5.02 (iris diameter distance). Preoperative inner-canthal angle of the left eye (PRCAL) values were (47.51±4.28)°, preoperative inner-canthal angle of the right eye (PRCAR) values were (47.30±4.55)°, 3-month-preoperative inner-canthal angle of the left eye (3POCAL) values were (49.53±5.15)°. 3-month-preoperative inner-canthal angle of the right eye (3POCAR) values were (49.24±4.86)°, 6 month-postperative inner-canthal angle of the left eye (6POCAL) values were (49.48±4.74)°, and 6 month-postperative inner-canthal angle of the right eye (6POCAR) values were (48.99±4.55)°. The difference between PRICD and 3POICD, PRICD and 6POICD, PRCAL and 3POCAL, PRCAL and 6POCAL, PRCAR and 3POCAR, PRCAR and 6POCAR were statistically significant (t=6.432, 6.307, -2.882, -3.188, -2.516, -2.248, P<0.05). The difference between 6POICD and 3POICD was statistically significant (t=4.047, P<0.05); moreover, the mean value of 6POICD was larger than the mean value of 3POICD. There was no significant difference between 6POCAL and 3POCAL, and 6POCAR and 3POCAR (t=0.352, P>0.05).@*Conclusions@#According to the result of the study, the continuous embedding method has a certain effect on shortening the intercanthal distance and changing the inner canthal angle. It is inferred that the continuous embedding method has a certain effect on the improvement of mild epicanthus.

Effectiveness of levator muscle resection combined with Mustarde's double Z-plasty for blepharophimosis-ptosis-epicanthus inversus syndrome / 中国修复重建外科杂志

Objective: To investigate the effectiveness of levator muscle resection combined with Mustarde's double Z-plasty to correct blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Methods: Between March 2015 and June 2017, one-stage operation of levator muscle resection combined with Mustarde's double Z-plasty were performed on 26 children with bilateral BPES. There were 16 boys and 10 girls with an average age of 7 years (range, 4-14 years). All patients marked the four typical signs of BPES. There were 7 cases accompanied with a low nasal bridge, and 20 cases with amblyopia and strabismus. The length of eye fissure was (19.5±4.5) mm, the width of eye fissure was (2.5±1.6) mm, the diameter of inner canthus was (42.1±6.5) mm, and the muscular strength of levator palpebrae superioris was (5.5±1.3) mm. Results: All the incisions healed by first intention. Twenty-three patients were followed up 2-12 months, with an average of 10 months. Among which, 2 cases were less corrected, 3 cases were over corrected, 6 cases had poor curvature of the eyelid. No eyelid internal and external pronation or keratitis occurred. Amelioration of blepharoptosis and epicanthus was achieved in the other patients, and the double eyelid fold was naturally smooth. At 7 days after operation, the length of eye fissure was (27.2±1.9) mm, the width of eye fissure was (12.5±1.3) mm, and diameter of inner canthus was (29.4±2.6) mm, which were superior to preoperative values ( t=0.127, P=0.042; t=0.341, P=0.029; t=0.258, P=0.038). There was no angular deformity caused by the width and length regressions of eye fissures. Conclusion: The levator muscle resection combined with Mustarde's double Z-plasty can effectively correct BPES and obtain good effectiveness.

Clinical application of horizontal transection of the triangular flap for epicanthal plasty / 中华整形外科杂志

Obiective@#To explore the method and clinical effect of epicanthal plasty.@*Methods@#Transverse incision of epicanthus was applied on the horizontal line of the epicanthus to separate and release the orbicularis oculi muscle and the fibrous tissue and moderately remove the abnormal orbicularis oculi muscle. The redundant triangular flap under the incision was removed, and the superficial ligament of epicanthus was sutured and fixed to the dorsal nasal fascia with 1 stitch, so as to achieve correcting the epicanthus.@*Results@#The epicanthus of the 121 patients was corrected after the surgery with their lacrimal caruncle exposed. The appearance of the endocanthion is pleasing, the skin of the endocanthion is smooth, the scar is invisible, and the oculi rimae is lengthened 1 to 3 mm.@*Conclusions@#The operation has achieved a satisfactory effect. Therefore, the horizontal transection to remove the triangular flap is applicable for most epicanthus due to its simplicity and practicality, as well as the invisible scar and simultaneous manipulation with other operations. These features might be significant for a wider clinical application.

The anatomical research progress and the surgical development of epicanthus / 中华整形外科杂志

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.

Effectiveness of a modified medial canthoplasty combined with upper eyelids blepharoplasty / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore a simple, flexible and effective approach for medial canthoplasty combined with upper eyelids blepharoplasty aiming to achieve the natural and ideal appearance of eyelid. <p>METHODS: From September 2011 to May 2015, 62 cases(124 eyes)had received canthoplasty combined with upper eyelids blepharoplasty for single-folding eyelids and epicanthus were enrolled. Following the common upper eyelid blepharoplasty, an incision was prolonged to the medial canthus and was subsequently embedded within the double eyelid line. To decrease the skin tension, the canthal ligament was decompressed. Depending on the ideal appearance of the canthus, the upper eyelid and canthus were reformed next to the removal of excess skin. Patients were followed up for 3mo to 1a. At 3, 6mo and 1a, patients were investigated for the appearance of the canthus and the cicatrices. <p>RESULTS: Totally 57 cases(114 eyes)had 1 to 12 months' follow-up. In these 57 cases, 51 patients satisfied with the permanent double eyelids and corrected epicanthus, 6 cases' eyelids(12 eyes)appearance were improved partly. No recurrent epicanthus or hyperplastic scar was found in our study. <p>CONCLUSION: This approach combines medial canthoplasty with upper eyelids blepharoplasty to expose the canthus widely, hide the incision and scar, decrease the skin tension efficiently and remove the excess skin flexibly, which is an ideal method to correct epicanthus and single upper eyelids.

Unilateral anterior persistent fetal vasculature in a child with blepharophimosis‑ptosis‑epicanthus inversus syndrome: A surgical challenge.

Blepharophimosis‑ptosis‑epicanthus inversus syndrome (BPES) is a rare autosomal dominant genetic disease. It is clinically characterized by four major features; blepharophimosis, ptosis, epicanthus inversus, and telecanthus. We report a case of a 1‑year‑old female with BPES with unilateral anterior persistent fetal vasculature (PFV). On examination, she was found to have all the clinical features of BPES, along with calcified and partially absorbed cataract with elongated ciliary processes in her left eye. B‑scan of left eye showed attached retina with no evidence of posterior PFV. Systemic examination was normal. She underwent cataract surgery with primary posterior capsulotomy with intraocular lens implantation under general anesthesia. Literature search did not reveal any previous reports of unilateral anterior PFV and BPES. The clinical features, other associations, and the difficulties in the surgical management of this condition are discussed.

Clinical efficacy of improved method of inverted L-shaped incision combined with medial canthal tendon plication for moderate and severe epicanthus correction / 中华医学美学美容杂志

Objective To explore the clinical effect of inverted L-shaped incision combined with medial canthal tendon plication for moderate and severe epicanthus correction.Methods Improved method of inverted L-shaped incision combined with medial canthal tendon plication were performed in 42 cases of moderate and severe epicanthus.The epicanthus covered more than 50％ lacrimal caruncle with single-fold eyelids or unconspicuous double-fold eyelids.Among them,40 cases received doubleeyelid plasty simultaneously.Results The follow-up time of 38 cases ranged from 6 to 24 months.37 cases received double-eyelid plasty simultaneously.All the patients obtained satisfactory results aesthetically,the contours of two eyelid fissures and the double-eyelid radian looked more natural postoperatively.There was no reoccurrence of epicanthus.Mild scar proliferation was observed in all of the patients in the early 1-2 months of postoperative period and then would fade within three months.Conclusions It is effective to correct epicanthus by improved method of inverted L-shaped incision combined with medial canthal tendon placation.

Individualized surgical treatment of congenital entropion / 中华医学美学美容杂志

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.

Michels syndrome: The first case report from India and review of literature.

Pediatric Ophthalmology and Strabismus Sevices, Jasti V Ramanamma Children’s Eye Care Center, L. V. Prasad Eye Institute, 1Rainbow Children’s Hospital, Hyderabad, Andhra Pradesh, India A 2‑year 7‑month‑old girl born out of a consanguineous marriage, presented at our facility with clinical features characterized by the eyelid triad of blepharophimosis, blepharoptosis and epicanthus inversus in association with hypertelorism, cleft palate and craniosynostosis. This constellation of features is suggestive of Michels syndrome. At the time of writing this report, there were only ten reported cases worldwide and to the best of our knowledge, there have been no published reports from India.

Novel occurrence of Axenfeld: Rieger syndrome in a patient with blepharophimosis ptosis epicanthus inversus syndrome.

is a complex eyelid malformation characterized by the classical tetrad of blepharophimosis, telecanthus, ptosis, and epicanthus inversus. It has been reported to be associated with other ocular anomalies such as euryblepharon, strabismus, nystagmus, amblyopia, microphthalmos, lacrimal drainage apparatus abnormality, extra ocular muscle abnormalities, microcornea, trabecular dysgenesis, optic nerve hypoplasias, and colobomas of the optic disk. We describe a case of BPES with Axenfeld–Rieger syndrome, a neurocristopathy characterized by maldevelopment of the anterior segment with predisposition to development of glaucoma. Interestingly, both syndromes are caused by mutations in the same class of genes, namely the winged‑helix/ forked transcription factors (FOX) involved in a variety of developmental processes.

Curative effect analysis of three methods of epicanthus combined with small incision for double eyelid surgery / 局解手术学杂志

Objective To explore an effective and hidden incision scar method for epicanthus correction. Methods 80 patients of bi-lateral single eyelid with epicanthus were divided into group A,group B and group C. Twenty-five patients with 50 eyes of group A received“Z” plasty correction of epicanthus,25 cases with 50 eyes of group B received the traditional“Y-V” plasty correction of epicanthus,30 cases with 60 eyes of group C treated with modified “Y-V” plasty correction of epicanthus. The curative effective was observed. Results Three groups were followed up for 6~24 months, the appearances of 25 patients in group A were significantly improved,of whom 2 cases had uni-lateral recurrence,8 cases with obvious postoperative scar. The eyelid shapes of patients in group B were natural after surgery,12 cases with obvious scar. all patients in group C were found no postoperative hypertrophic scars. Conclusion The three surgical treatment were effec-tive for epicanthus,but the design approaches of“Z” plasty correction and“Y-V” plasty correction are more complex,and postoperative scar is obvious,meanwhile the modified “Y-V” plasty correction is simple with incision hidden good shape scar formation.

Medial Epicanthoplasty Using a Modified Skin Redraping Method

BACKGROUND: The presence of an epicanthal fold is a distinctive characteristic of the eyelids in Asian population. Various medial epicanthoplasty techniques have been introduced to achieve aesthetic appearance. The objective of this article is to describe our modification of the previously performed medial epicanthoplasty procedures, minimizing deterioration of the original ciliary position and maximizing natural appearance. METHODS: From December of 2011 to February of 2013, total 386 patients with epicanthal folds have undergone medial epicanthoplasties using modified skin redraping method. The design of a new medial epicanthus, subciliary line of the lower eyelid and supratarsal fold line is crucial to this method. Intramuscular dissection and myotomy of the preseptal orbicularis oculi muscle are necessary to obtain natural eyelid position. RESULTS: Most of the patients showed satisfactory results aesthetically during the follow up period; from 3 months to 12 months, a mean of 7.5 months postoperatively. There was no recurrence of the epicanthal fold. There was not any patient who complained about postoperative complications including ectropion and visible scars around the medial canthal area. CONCLUSIONS: The results indicate that medial epicanthoplasty using a modified skin redraping method is reliable and feasible procedure to correct epicanthal fold maintaining natural eyelid appearance.

Effects of over the lower edge of the tarsal joint continuous suture fixation combined with orbital entire complex on eyelid epicanthus / 中国基层医药

Objective To investigate the continuous suture through the lower edge of the tarsal joint fixation orbital reconstructive eyelid superfluous skin treatment efficacy.Methods 50 cases of abject epicanthus clinical data were retrospectively analyzed from June 2009 to June 2013 in our hospital by the hospital ethics committee approved,which had a total of 100 eyes.According to the numbering method,they were randomly divided into control group and observation group,each 50 cases.Control group was given through the lower edge of the tarsal continuous suture fixation,while the observation group was treated on the basis of control group combined with joint orbital entire complex treatment.Therapeutic effects were compared,pain,treatment before and after each measurement indicators and lower eyelid skin complications and so on.Results After treatment,the control group redundant lower eyelid skin correction,eyelash contact with the cornea and corneal epithelial healing of eye damage were respectively 39 (78.00％),10 (20.00％) and 43 (86.00％),while the observation group were 49 (98.00％),1 (2.00％) and 50 (100.00％),the above parameters were statistically significant differences (x2 =5.559,16.839,3.840,P ＜ 0.05,P ＜ 0.01) ; According to VAS pain score,VAS scores before and after treatment were statistically significant (t =5.271,12.593,P ＜0.05,P ＜ 0.01),and the observation group after treatment VAS scores after treatment compared with the control group,the difference was statistically significant(t =4.399,P ＜ 0.05) ; Before and after treatment from the eyelid folds distance,flat as the lower eyelid away from the eye position,head lower eyelid skin flap in eyelid,head tilt eyelashes,inner canthal angle,outer canthal angle,inner canthal folds,palpebral fissure height,head of small tears on the pitch,orbicularis muscle eyelid width,eyelid orbicularis muscle thickness and orbital orbicularis muscle thickness differences were statistically significant,and the observation group after treatment with these indicators compared to the control group after treatment,the differences were statistically significant (t =4.292,5.828,4.135,5.099,4.723,5.002,6.717,8.092,7.038,8.056,3.129,7.043,P ＜ 0.05) ; the course of treatment in both groups would be lower eyelid retraction,ectropion and eyelid scar concurrent disease control group complication rate was 20.00％,which was significantly higher than that of the observation group(6.00％),the difference was significant statistical significance(x2 =13.283,P ＜ 0.01).Conclusion Over the lower edge of the tarsal joint continuous suture fixation treatment of orbital reconstructive eyelid superfluous skin effect is significant,with low complication rate,which is worth to be promoted in clinical and applied.

Correction of epicanthus by transverse incision and concurrent double-eyelid plasty / 中华医学美学美容杂志

Objective To explore epicanthus correction by transverse incision method and concurrent double-eyelid incision operation.Methods The transverse straight-line incision was performed in new inner canthus to the original canthal corner point; after the original inner canthus corner point was reached,the oblique-line parallel incision was performed along the lower eyelid so that full subcutaneous separation was obtained on the upper and lower incision; the malpositioned isomerous orbicular muscle and thickened tissue were released and excised so that the epicanthus skin was naturally restored; the superficial head of the inner canthus ligament was folded and sutured when necessary ; after small cat ears at the temporal side of the inner canthal incision was removed,routine double eyelid plasty was then performed,but the double eyelid and the inner canthus incisions were not continuous.Results The procedures were clinically applied in 258 cases and followed up for 3-18 months,showing that the epicanthus has disappeared,new inner canthus was in good appearance,the scar was not obvious,recurrence of the epicanthus was not found and double eyelids were beautiful in appearance.Conclusions The epicanthus correction by transverse incision and concurrent double-eyelid plasty is a simple and ideal approach for correction of single-edged eyelid with epicanthus and it is worthy of clinical promotion.

Application of modified minimally-invasive transverse-vertical epicanthoplasty in double-eyelid plastic with three points at the same period / 中国基层医药

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.

A modified transverse-vertical epicanthoplasty with concurrent double eyelid plasty / 中华医学美学美容杂志

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.