Revisional Medial Epicanthoplasty Using Reverse Z-Plasty Technique.

BACKGROUND: Medial epicanthoplasty is a common method for correcting epicanthal folds in Asians but sometimes cause unsatisfactory results. Although several procedural variations have been devised, revision techniques have earned little attention. The revision technique the authors have developed employs reverse Z-plasty to restore an overcorrected epicanthal fold. OBJECTIVES: The aim of this study was to investigate the effectiveness of the authors' reverse Z-plasty technique in restoring natural medial canthal region harmonizing with Asian face. METHODS: From January 2010 to December 2016, reverse Z-plasty was performed in patients seeking revisions after previous medial epicanthoplasties. Patients were surveyed to assess their satisfaction with surgical outcomes. Interepicanthal distance-lengthening ratios and symmetry of palpebral widths were evaluated digitally (ImageJ software) in patients who received revisional epicanthoplasty only. RESULTS: The reverse Z-plasty technique for revisional epicanthoplasty was performed in 548 Asian patients (83 males, 460 females). Most patients were pleased with the final outcomes. Only 6% submitted to later revisions of scars, which were otherwise scarcely visible after 3 months. Among 60 patients who underwent only revisional epicanthoplasty, interepicanthal distance-lengthening ratios ranged from 2.9% to 31.1% (average, 8.6%), and palpebral width symmetries improved. CONCLUSIONS: This particular technique helps restore the 3-dimensional appearance of medial canthal angle through horizontal skin and soft tissue (including muscle and ligament) restructuring, thus compensating for tissue deficiency. It is simple in design, easy to perform, and satisfactory results were achieved, conferring natural aesthetics to the medial canthal region.

Outcomes of surgical management of xanthelasma palpebrarum.

BACKGROUND: Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. METHODS: A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. RESULTS: Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. CONCLUSIONS: We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.