Dual‐plane epicanthoplasty in Chinese blepharoplasty

Abstract

Background The ethnically characteristic upper eyelids of many Chinese individuals include medial epicanthal folds, substantial fatty tissue, a laxity of pretarsal skin, and a lack of superior palpebral folds. Different epicanthoplasty techniques have been described in the literature. However, postoperative medial canthal scarring remains a concern. Objectives This article introduces a novel technique that minimizes the risk of postoperative canthal scarring. Methods Dual‐plane epicanthoplasty involves an advanced skin flap and a rotation skin flap, which are, respectively, distributed on the outer skin lining and inner skin lining and belong to the different three‐dimensional planes of the epicanthus. The dense connective fibers located between the skin and the orbicularis oculi muscle were completely released. In the final steps, the upper advanced triangle flap was anchored in the direction of the lacrimal caruncle and the lower rotation triangular flap was anchored to the nasal skin. Results From January 2016 to September 2018, 216 patients were enrolled in the cohort undergoing dual‐plane epicanthoplasty, with 172 patients undergoing the concomitant double eyelidplasty. For 206 of the cases, follow‐up lasted for over 6 months, with a median time of 11 months. Except for one patient (0.49%) who may need a revision procedure for a prominent scar, all other patients (99.51%) achieved natural and cosmetically desirable appearances with adequate lacrimal caruncle exposure and minimal postoperative medial canthal scaring. Conclusion Dual‐plane epicanthoplasty, with or without double eyelidplasty, is a novel and effective surgical technique modified for Chinese patients with good esthetic outcomes.

Asian upper blepharoplasty and dual‐plane epicanthoplasty: An integrated four‐step technique

“…Our dual-plane epicanthoplasty involved two triangular flaps, the upper advanced flap and the lower rotation flap. 13 As the first step, we created the upper advanced triangle flap of epicanthoplasty and severed the malpositioned orbicularis muscle fiber underneath the epicanthal fold to release the horizontal tension. With the second step, Asian blepharoplasty was performed and the muscle underneath the discontinuous incision was resected, so that the pull vector from upper eyelid was reduced.…”

“…Point D was designed after all the pull vectors were completely released, thus was not marked at the beginning (Figures 1 and 2). 13 …”

“…Point D was designed after all the pull vectors were completely released, thus was not marked at the beginning (Figures 1 and 2). 13 Then, a smooth supratarsal crease line was marked, mostly not connected to Point C, as a discontinuous incision (Figure 2).…”

“…Comparison of commonly used epicanthoplastyPros ConsPark Z 4 Simple design, scar is not obvious Vertical scar at the nasal side, can be noticeableRoot Z 1Scar maintained within the eyelid skin Complicated excision of epicanthal tissue Skin redraping9,10 Scar is well hidden, simple design To eliminate the dog ear in the lower eyelid often leaves a relatively long scar; sometimes the inner canthus angle become obtuseLazy S curve11 Scar is well hidden Has to be continuous with the double-eyelid incision Dual-plane epicanthoplasty13 Without vertical scar, three-dimensional flaps intersecting, scar is well hidden…”

Will the patient’s double eyelid shape be like that of the surgeon performing the procedure? A study of surgeons’ aesthetics in East Asian Blepharoplasty

“…As a consequence of the enormous difference in personal aesthetics, the dissatisfaction of patients with double eyelid surgery also occurs frequently, sometimes leading to a high litigation rate. For a long time, compared with a large number of studies on surgical techniques, there have been insufficient studies on aesthetic concepts which mainly focused on the eye fissure height, crease width etc 1,3,4 As a surgical operation based primarily on aesthetics, the influence of the surgeon's subjective aesthetics on surgical outcomes should not be ignored. Studies have shown that complex individual facial aesthetics are related to the familiarity produced by visual exposure, by which way the individual's appearance may affect the individual's aesthetics to some extent 5‐7 .…”