A comparative retrospective analysis: myocutaneous flap versus skin flap in V-Y medial epicanthal fold reconstruction.

Objectives: To evaluate the comparation of myocutaneous flap vs. skin flap in V-Y medial epicanthal fold reconstruction. Methods: The study, conducted from April 2017 to June 2022, involved two groups: group A, comprising 21 patients who underwent medial epicanthal fold restoration surgery using the V-Y advancement method with a skin flap, and group B, comprising 83 patients who underwent the same procedure, while with a myocutaneous flap for orbicularis oculi ring reconstruction. Intercanthal distances were measured preoperatively, recorded during preoperative and postoperative reviews, and assessed through a 4-point Likert satisfaction questionnaire. Results: A total of 104 patients were followed up for 6 months postoperatively. In group A, preoperative intercanthal distances ranged from 28.7 mm to 38.2 mm, increasing to 30.2 mm-40.6 mm postoperatively, with a mean increase of 3.0 mm (P < 0.05). In group B, preoperative distances ranged from 28.8 mm to 38.0 mm, increasing to 32.2 mm-41.5 mm postoperatively, with a mean increase of 3.9 mm (P < 0.05). Group B exhibited a higher overall satisfaction rate compared to group A. Conclusion: The myocutaneous flap V-Y procedure, employing the principle of orbicularis oculi ring reconstruction, achieves more stable postoperative results than the flap-only V-Y procedure. Consequently, it can be regarded as the preferred surgical technique.

A Novel Thunderbolt Z-Epicanthoplasty for Asians.

BACKGROUND: Although many epicanthoplasty techniques have been proposed, prominent hypertrophic scarring in the medial canthal region remains a problem. The aim of this study was to develop a novel design that has a less prominent scar with minimal tension. METHODS: A total of 489 patients underwent thunderbolt Z-epicanthoplasty from July 2015 to April 2019, with or without blepharoplasty. A triangular myocutaneous flap was lifted from the upper part of the epicanthal fold. The surrounding area was dissected to remove the rigid connective tissue between the orbicularis muscle and the skin, which creates skin tension. A Z-shaped flap toward the inferomedial canthal portion was added to create space for the triangular flap to be transposed to change the straight incision into a curved zigzag incision (final scar in the shape of a "thunderbolt"), making the scar irregular and less conspicuous. RESULTS: Postoperatively, all patients were followed up for ≥ 12 months. Among the patients, epicanthus tarsalis (60.12%) and palpebralis (36.19%) were the commonest epicanthus types, followed by epicanthus supraciliaris (3.07%) and inversus (0.61%). The average preoperative intercanthal distance was 42.25 ± 1.66 mm. This distance decreased significantly to 37.14 ± 1.78 mm (average, 5.11 ± 0.21 mm; p = 0.036) at the 12-month postoperative follow-up. Mild cicatricial redness was observed in the medial canthal area in six patients (1.2%) during the early postoperative period. The redness diminished within 6 months postoperatively. All patients obtained natural and aesthetically pleasing results without prominent hypertrophic scarring or other complications in the medial canthal area. CONCLUSION: The thunderbolt Z-epicanthoplasty is safe and effective for treating medial epicanthal folds. It is potentially helpful in minimizing postoperative medial canthal scarring and can be applied to various types of epicanthal folds with long-lasting results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Non-Surgical Aesthetic IV.

Reconstruction of medial epicanthal fold using v-y advancement and turnover flap.

BACKGROUND: Since the 1900s, many methods have been developed to correct the epicanthal fold. Increased use of epicanthoplasty has yielded unsatisfactory results. OBJECTIVES: To describe a method of epicanthal fold reconstruction using V-Y advancement and turnover flap for clinical application. This method is simpler than conventional surgery. It is easy to perform with excellent esthetic results. METHODS: The authors performed medial epicanthal fold reconstruction in 82 patients (16 males and 66 females) between April 2014 and September 2017. All patients enrolled in this retrospective study underwent surgical procedures at the authors' institution. Interepicanthal distance was the distance between medial epicanthal folds. It was measured with a surgical ruler. RESULTS: Before surgery, mean interepicanthal distance was 35.4 mm. Using our surgical technique, successful outcome was achieved in 79 (96.3%) patients with satisfactory results. The mean distance between the medial epicanthi post-surgery was 38.6 mm, increasing the total length by 3.2 mm without showing any major postsurgical complications. DISCUSSION: Epicanthal fold reconstruction using V-Y advancement and turnover flap is a simple and effective technique that can readily improve the frontal view. It improves periorbital contouring, makes eyes look natural without fully showing the caruncle, and yields excellent esthetic results. In particular, there were no major visible scars following eversion suture.

Epiblepharon correction in Korean children based on the epicanthal pathology.

PURPOSE: This study aims to investigate the surgical outcomes of a novel epiblepharon correction method based on the pathologic features of epicanthal tissue. The correlation between the pathology and clinical presentations was also studied. METHODS: This retrospective study included 72 eyelids of 36 children with epiblepharon and epicanthal folds. From July 2013 to March 2016, epicanthal tension-releasing procedure of subdermal fibrinolysis with orbicularis oculi ring myotomy were performed in 36 children. Photographs before and after operation were analyzed with Image J program. A clinical severity of the epiblepharon was scored based on the lower eyelid skin fold height (mild to severe). Subdermal fibrosis index was defined as the portion of fibrosis in low power field (× 40) and eyelid contour was assessed with custom software (MATLAB). Eighty eyelids without eyelid pathology were analyzed to establish the normal eyelid contour. The epicanthal tissues were classified into three categories: mild, moderate, and severe fibrosis. RESULTS: The mean age of the patients was 5.5 years. Intercanthal distance (ICD) ratio was defined as Inner ICD (IICD)/outer ICD (OICD). The IICD/OICD was 0.41 in the severe epiblepharon group that is significantly longer compared to that of the mild epiblepharon group (0.38). Subdermal fibrosis index was higher in severe epiblepharon group. Eyelid contour was normalized and the cilia touch was resolved after the epicanthal tension-releasing procedure. CONCLUSION: Epicanthal tension-releasing procedure with orbicularis oculi ring myotomy achieved favorable surgical outcomes. Clinical correlations with pathologic findings and satisfactory results of the procedure suggest that medial epicanthal fibrosis is the main pathologic feature causing epiblepharon and epicanthal folds.

Cosmetic and structural outcomes of two different techniques of medial epicanthoplasty according to epicanthal fold classification and severity: A cohort study.

AIM: This study aimed to compare the cosmetic and structural outcomes of two techniques for medial epicanthoplasty of the epicanthal fold, which varied in classification and severity. METHODS: Medical records and photographs of 106 patients (212 eyes) who underwent medial epicanthoplasty by the modified Z-plasty or modified redraping techniques were reviewed retrospectively. They underwent surgery from January 2009 to June 2017 and completed a follow-up of 6 months. The cosmetic outcome was evaluated in terms of satisfactory, symmetry, smoothness, and scarring by a four-point scoring method, and the structural outcome was assessed by the ratio of intercanthal distance (ICD) and interpupillary distance (IPD). The two surgical techniques in the same epicanthal classification and severity were compared and analyzed. RESULTS: The modified Z-plasty and modified redraping techniques had similar outcomes for satisfaction level in all types of epicanthal folds. The modified Z-plasty scored significantly higher for scarring in mild, moderate, and severe epicanthus palpebralis (p = 0.034, 0.028, and 0.013, respectively). The modified redraping technique scored significantly higher for smoothness in mild epicanthus tarsalis (p = 0.025). In epicanthus palpebralis, the postoperative ICD/IPD ratio in the redraping technique was significantly low (p = 0.001 and 0.000, respectively), whereas the preoperative ratio showed no significant difference. In epicanthus tarsalis, the postoperative ICD/IPD ratio showed no significant difference, whereas the preoperative ratio showed significantly difference (p = 0.011 and 0.002, respectively). CONCLUSIONS: The modified Z-plasty provided less scarring in epicanthus palpebralis. The modified redraping technique provided more smoothness in mild epicanthus tarsalis, and it was more efficient in shortening the ICD.

Epicanthoplasty with Epicanthal Dermatic Tension-Releasing Incision Based on Skin Projection of Inner Canthal Ligament.

BACKGROUND: Epicanthoplasty is a reconstructive procedure that eliminates the deformity of the epicanthal fold and provides a more esthetic inner canthus. The epicanthal tension-releasing incision is a core technique of epicanthoplasty. However, which epicanthal dermatic tension-releasing incision most effectively provides epicanthal tension release remains unclear. We designed a novel dermatic tension-releasing incision based on the skin projection of the inner canthal ligament and compared it with the more conventional incision parallel to the lower inner canthal mucocutaneous junction (white line). METHODS: From December 2014 to March 2016, 30 patients were divided into two groups according to the type of dermatic tension-releasing incision. Each group comprised 15 patients and 30 eyes. In Group A, incision line a was performed (tension-releasing incision parallel to the lower inner canthal mucocutaneous junction, 4-5 mm away from the mucocutaneous junction). In Group B, incision line b was performed (tension-releasing incision pointed toward the lacrimal lake, along the skin projection of the inner canthal ligament). The defect angles of the two groups were photographed intraoperatively after tension release and analyzed postoperatively. RESULTS: The defect angles in Group B were significantly larger than group A (P < 0.0001). All patients obtained an esthetically pleasing inner canthus without hypertrophic scarring or injury to the lacrimal apparatus during the 3- to 24-month follow-up period. CONCLUSION: An epicanthal dermatic tension-releasing incision based on the skin projection of the inner canthal ligament is more effective and safer than an incision parallel to the lower inner canthal mucocutaneous junction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The orbicularis oculi muscle resection technique for medial epicanthoplasty: A retrospective review of surgical outcomes in 47 Chinese patients.

BACKGROUND: Epicanthal folds and single eyelids are considered characteristic East Asian traits. This study describes a new approach to medial epicanthoplasty based on an orbicularis oculi muscle resection technique and reports the surgical outcomes in Chinese patients. METHODS: The study presents an uncontrolled retrospective case series review of 47 Chinese patients who underwent medial epicanthoplasty with double eyelid surgery from December 2010 to December 2014 by traditional medial epicanthoplasty (Group I, n = 23) or medial epicanthoplasty using the orbicularis oculi muscle resection technique (Group II, n = 24). Horizontal lid fissure length (HLFL), inner intercanthal distance (IICD), and the HLFL/IICD ratio were measured preoperatively and at 6-month follow-up. Within group and between group comparisons were performed using paired t-test, independent t-test, and Chi-square test. Pre- and postoperative photographic images were compared. RESULTS: In Group I, mean IICD decreased from 38.8 ± 1.06 mm preoperatively to 33.7 ± 0.93 mm postoperatively, and mean HLFL increased from 24.9 ± 1.27 to 29.6 ± 0.63 mm (p < 0.01). The HLFL/IICD ratio increased to 0.237 ± 0.05 (p < 0.0001). In Group II, mean IICD decreased from 38.7 ± 1.30 mm preoperatively to 32.2 ± 1.13 mm postoperatively, and mean HLFL increased from 24.5 ± 1.72 to 30.6 ± 1.08 mm (p < 0.01). The HLFL/IICD ratio increased to 0.315 ± 0.047 (p < 0.0001). The improvement in the HLFL/IICD ratio was significantly higher in Group II than in Group I (p < 0.001). All patients obtained satisfactory results with no complications. CONCLUSIONS: Medial epicanthoplasty using the orbicularis oculi muscle resection technique is safe and effective for epicanthal fold correction in Chinese patients.

A Novel U-Flap Epicanthoplasty for Asian Patients.

BACKGROUND: The epicanthal fold is a distinct characteristic of the Asian upper eyelid, which may impair the beauty of the eyes and the outcome of double eyelid blepharoplasty. Although many surgical procedures have been reported, their main drawbacks include a conspicuous scar in the medial canthal area and an unnatural palpebral contour. We devised a novel surgical approach to correct the epicanthal fold with acceptable scarring. METHODS: From June 2011 to October 2014, U-flap epicanthoplasty was performed on 118 Chinese patients in our department. The U-flap was designed on the medial canthal skin. After complete dissection of the flap from the dislocated orbicularis muscle and underlying connective tissue, the flap naturally rotated upward to a line consistent with the direction of the palpebral fold. The flap was then subcutaneously fixed to the medial part of the medial canthal ligament. Finally, the redundant skin was trimmed off and the incision was sutured without tension. Patients were evaluated before and 12 months after surgery. RESULTS: The average decrease in the intercanthal distance was 4.36 ± 0.32 mm. The general satisfaction rate was 97.5 %. Three patients showed bilateral hypertrophic scar formation on both bilateral medial canthal incisions and palpebral incisions; however, the scarring subsided after three triamcinolone acetonide injections. No epicanthal fold recurrence or other complications were observed during the 12-month follow-up period. CONCLUSION: U-flap epicanthoplasty is a simple and effective method for elimination of types I-III epicanthal folds. However, its long-term effects require further study. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medial lower lid epiblepharon repair solely by skin-redraping medial epicanthoplasty.

BACKGROUND/AIMS: To evaluate clinical efficacy of a procedure using solely skin-redraping medial epicanthoplasty without traditional epiblepharon correction methods in patients with medial lower lid epiblepharon with epicanthal fold. METHODS: This clinical practice study included 24 eyes of 12 patients with medial lower lid epiblepharon who underwent epiblepharon repairs from January to September 2012. The patients included were those whose cilia touch disappeared with medial epicanthal fold traction for temporary medial epicanthal fold repair during preoperative examination. The patients underwent the sole procedure of skin-redraping medial epicanthoplasty. RESULTS: The mean age was 7.50 ± 3.23 years and the mean period of follow-up was 12.5 ± 3.80 months. Complete correction of cilia touch was observed in all patients. Surgical complications such as canalicular injury, skin fold, severe hypertrophic scar and excessive haemorrhage were not observed in any patients. Cosmetic results of surgical intervention were considered satisfactory by all patients, including one case of mild scar formation. There was no recurrence during the follow-up period. CONCLUSIONS: For patients with medial lower lid epiblepharon with epicanthal fold without excessive skin and muscle, a simple skin-redraping medial epicanthoplasty without traditional epiblepharon correction methods showed good results of epiblepharon repair.

Modified facial bipartition.

Orbital hypertelorism is a craniofacial abnormality that arises on its own or as part of a number of syndromes. It is not uncommon to find the condition in association with maxillary hypoplasia. This manuscript reports an uncommon case of Tessier 2, 12 with orbital hypertelorism and dentoskeletal maxillary prognathism. To correct the condition, the first stage procedure was a modification of facial bipartition, according to the need of the case, followed by correction of alar cleft by Denonvilliers technique.

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.

Oriental upper blepharoplasty.

Aesthetic surgery of the upper eyelids is a very common procedure performed in cosmetic practices around the world. The word blepharoplasty, however, has a different meaning in Asia than it does elsewhere. Orientals have different periorbital anatomic characteristics, their motivations for seeking eyelid treatment are different, and operative techniques have been adapted consequently. There are also many eyelid shapes among Orientals, mostly with regard to the presence and location of the supratarsal fold and/or presence of an epicanthal fold. The surgeon must therefore master a range of surgical procedures to treat these variations adequately. It is critical to know the indications for each blepharoplasty technique as well as their complications to select the right surgery and avoid unfavorable results. Epicanthoplasty performed on the right patient can greatly improve aesthetic results while retaining ethnic characteristics. This article will discuss Oriental eyelid characteristics, preoperative patient assessment, commonly used corrective techniques for the "double-eyelid" creation, and complications and how to avoid them.

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.