Anchor Epicanthoplasty Combined with OutFold Type Double Eyelidplasty for Asians: Do We Have to Make an Additional Scar to Correct the Asian Epicanthal Fold?

Abstract

A surgical incision after suturing usually leaves a visible scar on the hair-bearing skin, even after optimal wound conditions. The conspicuousness of such a scar results from its linear continuity and hairlessness. To prevent this effect, a row of micrografts or minigrafts was inserted between the wound edges immediately after wound closure. The hair grafts that were transplanted were dissected from the discharged skin in the same surgical procedure, if feasible. Otherwise, a mini donor strip was harvested from the mastoid scalp to dissect the hair grafts. The final linear scar was interrupted and concealed sufficiently with the growth of the transplanted hairs. Tension-free closure is required to obtain a satisfactory result with this technique.

Eyelid Incision for Dacryocystorhinostomy in Asians

“…10 The epicanthal fold consists of strips of muscles and dense connective tissues that originate from the medial canthal tendon and extend to the lower eyelid. 12 In planning an eyelid incision for dacryocystorhinostomy, the medial end of the incision line should not cross the epicanthal fold. Harris et al 3 designed the incision line from the point 10 mm medial to the medial canthus, slightly below the level of the medial canthal tendon, into the first lower eyelid crease.…”

Lazy S-curve Epicanthoplasty in Asian Blepharoplasty

“…Based on observations from anatomical dissections, Lee et al [3] suggested that the insertion of superficial fibers of the medial canthal ligament and orbicularis oculi muscle running through the fold was the primary cause of the Asian epicanthal fold. They also reasoned that the orbicularis oculi muscle fibers running through the epicanthal fold belonged mostly to the preseptal portion.…”

“…However, it can leave a prominent vertical scar at the nasal side when the epicanthal fold is severe. To avoid additional scars, Lee [3] used anchor epicanthoplasty combined with an out-fold-type double-eyelid plasty for Asians. The disadvantages of this procedure are that it is technically difficult, and thus there is a learning curve to avoid minor revisions, and there is the possibility of active bleeding, which makes the operation more difficult and time-consuming.…”

“…However, the presence of an epicanthal fold weakens the surgical outcome. A double-eyelid plasty without correction of the epicanthus usually creates a tighter skin curtain that makes the palpebral folds shorter and narrower and makes the eyelid fissure appear round and unnatural [2,3]. Epicanthoplasty enhances the aesthetic result of double-eyelid blepharoplasty by lengthening the palpebral fissure and is becoming a more and more popular operation.…”

A Novel U-Flap Epicanthoplasty for Asian Patients

“…More recently, Mu and colleagues [9] developed the lazy-S surgical technique, in which double eyelid blepharoplasty and epicanthoplasty are completed in a single procedure. Despite the improvements in epicanthoplasty techniques, their main drawback remains a conspicuous scar in the medial canthal area [10]. We herein present a tension-free U-flap epicanthoplasty technique that achieves maximal anatomical restoration of the dislocated orbicularis oculi and minimal scar formation.…”