Correction of the epicanthal fold using the VM-plasty

Medial Epicanthal Fold Correction Using a Y-W Epicanthoplasty in Asian Eyelids

Many surgical techniques for managing epicanthal folds have been reported, but their main drawbacks include a noticeable scar in Asians, acute medial canthal angle, and applicability only in mild or moderate epicanthal folds. This study described a novel surgical technique, Y-W epicanthoplasty, and assessed the medial canthal shape and scarring in patients who underwent Y-W epicanthoplasty. Patients with moderate or severe epicanthal folds between January 2004 and February 2017 were included in this study. Pre- and postoperative intercanthal distance (ICD), inner canthal angle (ICA), and interpupillary distance (IPD) were measured. The ICD ratios (ICD/IPD) and extent of postoperative scarring were evaluated. A Y-W epicanthoplasty was performed on 18 patients. The ICD ratio of the total study cohort showed a significant reduction following surgery (preoperative ICD ratio=0.62±0.04, postoperative ICD ratio=0.58±0.03, P<0.001). The ICA was 51.8±7.7° and 49.8±5.6° in the pre- and postoperative periods, respectively (P=0.086) Eleven patients showed no apparent scar, and 6 patients were found to have minimal scarring that was visible only under close inspection. One patient had a hypertrophic scar that was successfully managed with triamcinolone acetonide injections. Y-W epicanthoplasty can provide good aesthetic results without a visible scar in patients with moderate-to-severe epicanthal folds. The Y-W epicanthoplasty avoids a medially extended skin incision and excessive tension on the skin flaps. Moreover, an acutely shaped or webbed medial canthus after epicanthoplasty can be prevented by adding a small triangular flap. The Y-W epicanthoplasty procedure is simple and straightforward, and it is appropriate for moderate-to-severe epicanthal fold correction.

Surgical Results and Patient Satisfaction After A New Surgical Technique for Asian Medial Epicanthoplasty: A Modified Skin Redraping Method Using a Horizontal Point Incision and Staged 'Y-Shaped' Dog Ear Correction

BACKGROUND

The double eyelid operation is the most common cosmetic procedure conducted in Asians. However, the epicanthal fold presents a conundrum that limits the cosmetic results of double eyelid surgery. Despite not being a pathologic condition, numerous procedures have been developed and introduced to address this issue, but these techniques have potential disadvantages that include an unnatural ciliary position of the lower lids and prominent scarring.

METHOD

A total of 156 patients who underwent a double eyelid operation with medial epicanthoplasty using the modified skin redraping method using a horizontal point incision and staged dog ear correction between 2015 and 2019 at our medical center were enrolled in the study. A single senior plastic surgeon performed all surgical procedures. The Patient-Reported Outcome Measures (PROM) questionnaire was used to obtain objective satisfaction scores, and patient satisfaction scores were obtained using some criteria.

RESULT

Of 147 patients, 8 (0.05) complained of visible scarring at the medial epicanthal and upper fold line region; there were only 2 (0.01%) epicanthal fold recurrences and 1.36% wound-related complications. The PROM scores and patient satisfaction scores showed a strong positive linear correlation according to linear regression analysis (P < 0.001).

CONCLUSION

We performed double eyelidplasty with epicanthoplasty by using "a modified skin redraping method using a horizontal point incision and a staged 'Y-shaped' dog ear correction." Few complications were encountered, and almost all patients were satisfied with their surgical outcome as determined by the PROM questionnaire.

Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar

BACKGROUND

Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty.

METHODS

The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V-Y flap and the rest had V-Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape.

RESULTS

The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved.

CONCLUSIONS

Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty.

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 .

Scarless Epicanthoplasty and Concomitant Double Eyelidplasty in Chinese Eyelids

BACKGROUND

The presence of mild or moderate medial epicanthus is typical in Asian patients. Numerous epicanthoplasty techniques have been described previously. However, these methods usually leave obvious scars in the medial canthal area. The aim of this report is to introduce a novel epicanthoplasty technique and a concomitant double eyelidplasty which avoid leaving scars in the medial canthal region.

METHODS

From July 2013 to July 2015, 252 patients received epicanthoplasty and concomitant double eyelidplasty with this new technique. The medial epicanthus was corrected through the medial end of the eyelid crease incision. One hundred eighteen of these patients were followed up for 3-24 months (8 months in average). The preoperative and postoperative interepicanthal distances were measured at pre, 3 and 6 months post-operation. The aesthetic results were evaluated with patient visual analog scale (VAS) scores.

RESULTS

The average intercanthal distance significantly decreased 3 months after the operation (32.7 ± 2.3 mm vs 36.5 ± 2.6 mm, p < 0.05, paired t test). Little retraction was noticed at 6 months after the operation (33.0 ± 2.4 vs 32.7 ± 2.3 mm, p < 0.05, paired t test). The mean patient VAS score associated with satisfaction of overall outcome was 4.2 at 6 months after operation (range 2.5-5.0).

CONCLUSION

This new method provides an effective way to correct the medial epicanthus without leaving any scar in the medial canthal region. Patients with mild to moderate medial epicanthus are good candidates for this procedure.

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 .

Two-Z-epicanthoplasty in a three-dimensional model of Asian eyelids

BACKGROUND

Epicanthoplasty is a procedure currently available for medial epicanthus correction. However, potential problems such as difficult designs, undercorrection, and unpleasant scarring in the medial canthus area make patients hesitant about undergoing epicanthoplasty. These barriers are challenges to surgeons.

METHODS

From January 2007 to May 2010, epicanthoplasty was performed for 23 patients using two-Z-plasty in a three-dimensional surgery model. A total of 20 patients underwent a simultaneous double-eyelid operation when required. The medial canthal distance was measured preoperatively and 12 months postoperatively. The extent of postoperative scarring and improvement of the epicanthal fold were evaluated after surgery.

RESULTS

The average intercanthal length decreased significantly from a mean of 37.0±2.1 mm preoperatively to 31.4±1.9 mm 12 months postoperatively (p<0.01, paired t test). Epicanthoplasty yielded excellent aesthetic results in terms of an open medial canthus without definite relapse, hypertrophic scarring, and injury of the lacrimal apparatus during the 12-month follow-up period.

CONCLUSIONS

Two-Z-epicanthoplasty can be reproduced easily in a three-dimensional surgery model. This procedure is very effective for correction of the epicanthal fold, resulting in a pleasant-appearing, inconspicuous scar and a long-lasting outcome.

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 http://www.springer.com/00266.

Comparing the eyes depicted in Japanese portraits of beautiful women: the Meiji and modern periods

BACKGROUND

The women portrayed in the bijin-ga of the past, particularly those from the Meiji Period (1868–1912), tended not to show much resemblance to those of women portrayed in the more modern bijin-ga (from after World War II), and such an observation came across as a possible indication that Japanese standards of beauty have changed over the two eras. To examine whether the apparent discrepancy can be interpreted as an actual change in the standards or not, a study was designed with the aim of assigning numeric values to several aspects of the eyes and testing for the presence of a statistically significant difference in each of the aspects between the Meiji bijin-ga and the modern bijin-ga.

METHODS

For this study, 29 Meiji bijin-ga and 36 modern bijin-ga were selected. The eye was chosen as the subject of comparison, and five aspects were categorized and measured: (1) presence or absence of a double fold, (2) eye width, (3) eye height, (4) eyebrow-to-upper lid distance, and (D) corneal diameter. The eye width, the eye height, and the eyebrow-to-upper lid distance were divided by the corneal diameter to derive standardized grounds for comparison.

RESULTS

The difference in double-fold frequencies between the Meiji bijin-ga (24%) and the modern bijin-ga (36%) was not found to be statistically significant (p=0.298). There was no difference in the eye width-to-corneal diameter ratio between the Meiji bijin-ga (mean 2.57±0.6) and the modern bijin-ga (mean 2.61±0.85) (p=0.86). The eye height-to-corneal diameter ratio derived from the Meiji bijin-ga (mean 0.62±0.15) was significantly smaller than that derived from the modern bijin-ga (mean 0.82±0.18) (p=0.000). The eyebrow to upper lid distance-to-corneal diameter ratio derived from the Meiji bijin-ga (mean 2.21±0.83) was significantly greater than that derived from the modern bijin-ga (mean 1.36±0.78) (p=0.000).

CONCLUSIONS

The results of the study support the notion that Westernization contributed to bringing about changes in the Japanese standards of beautiful eyes in the context of bijin-ga. However, the fact that the changeover has not occurred in all the categories in question does not indicate that the Occidental characteristics came to be emulated in their entirety.

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 at http://www.springer.com/00266.

A modified and accurately designed Z-epicanthoplastic technique

Surgical creation of a supratarsal crease has been by far the most common cosmetic procedure in China. To gain a pleasing eye appearance, double-eyelid surgery usually is performed in combination with epicanthoplasty. Currently, many epicanthoplastic techniques are described. Essentially, among the various epicanthoplasties, quite a few procedures are different designs of the Z-plastic or Y-V technique. In the authors' opinion, a better cosmetic result depends on a specific design more than the procedure itself. This report describes a modified Z-epicanthoplastic technique with accurate design and different types of tissue flaps raised. The authors performed epicanthoplasties with the Z-plastic technique for 163 patients from December 2006 to December 2010. Interepicanthal distances longer than a palpebral fissure and lacrimal caruncles obviously covered by epicanthic folds were considered an indication for performing epicanthoplasty. The follow-up period ranged from 4 months to 4 years. A good result was obtained, with natural fine creases of the upper eyelids and complete caruncle exposure at the near inner canthus. There was no shadow or local depressed deformity, visible scar in the inner canthus, or recurrence, and most of the patients showed slight westernizations of the medial eye architecture rather than wide and prominent western upper eyelid creases at the medial eyelids. Three patients had slight asymmetric exposure of the lacrimal caruncle, which was corrected by a second surgery. In conclusion, the modified and accurately designed Z-epicanthoplasty can avoid some complications such as local depressed deformity, displeasing appearance, and excessive westernized architecture at the inner canthus. A predictable shape in the medial corner can be obtained by developing and accurately designing different types of flaps.

A new method using epidural catheters in the reconstruction of lacrimal drainage

Lacrimal outflow obstruction after severance of the duct is a common problem in facial trauma. Conventional treatments include external dacryocystorhinostomy, endoscopic-assisted dacryocystorhinostomy, conjunctivorhinostomy, and a Jones tube bypass. However, the disadvantages of these methods are that the procedures are complicated and there is a high rate of recurrence. From April 2000 to March 2003, seven patients with epiphora after facial trauma had their lacrimal ducts drained with epidural catheters. The V-M shape incision was used with an epidural catheter placed as a stent for six months. After removal of the tube, all patients recovered fully from the epiphora during the follow-up period, and there were no complications.

Management of difficult pediatric facial burns: reconstruction of burn-related lower eyelid ectropion and perioral contractures

Despite significant burn treatment advances, modern multidisciplinary care, and improved survival after burns, facial burn scars remain clinically challenging. Achieving a successful reconstruction requires a comprehensive approach, entailing many advanced techniques with an emphasis on preserving function and balancing intricate aesthetic requirements. Pediatric facial burns present the same reconstructive challenges seen in adults, with additional developmental and psychologic concerns. In this paper, we describe the basic principals of facial burn care in the pediatric burn population, with a specific focus on lower-eyelid burn ectropion and oral commissure burn scar contracture leading to microstomia. Several cases are demonstrated.

Double eyelid blepharoplasty incorporating epicanthoplasty using Y-V advancement procedure

Ethnic characteristics of the Asian upper eyelid include the lack of a superior palpebral fold, excessive fat, laxity of pretarsal skin, and medial epicanthal fold. Historically, these features have characterised a unique beauty in Asians. With the increase of cultural exchange, the sense of beauty has changed greatly among Asians and most Asians regard eyes with double eyelids as beautiful. Therefore, surgical creation of a superior palpebral fold (so-called double eyelidplasty) has become the most common cosmetic operation in Asia. However, the presence of an epicanthal fold weakens the aesthetic results of the operation. The size of the epicanthal fold in Asians, whilst varying widely among individuals, is usually relatively small, and thus aesthetically successful effacement rarely requires more complex procedures as performed in the West. The incision for epicanthoplasty should therefore be as simple as possible and be confined to the eyelid area. From October 2001 to May 2006, Y-V advancement procedure for epicanthoplasty was used in combination with double eyelid surgery in 92 cases. Most of the patients attained satisfactory results. There were few complications in our series. A hypertrophic scar was recorded in three early cases and faded within 2 to 3 months with satisfactory results. This procedure is simple and more suitable for people of oriental origin.