Lazy S-curve Epicanthoplasty in Asian Blepharoplasty

Liu, Yulan; Lei, Ming; Wang, Yimin; Mu, Xin

doi:10.1007/s00266-011-9806-9

Cited by 27 publications

(12 citation statements)

References 15 publications

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“…Mustarde's 4‐flap method 13 works well in cases of severe epicanthal folds with rare recurrences; however, in Asians, the scar is noticeable, and therefore, the medial canthal area appears unnatural. Lazy S‐curve epicanthoplasty needs to be continuous with the double‐eyelid incision 6 . Invisible scar medial epicanthoplasty hides the incision in an area where it cannot be seen directly.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of surgical techniques to remove the epicanthus have been reported in the literature, including various Z plastics, 1,2 the Y‐V advancement flap, 3 V‐W plasty, 4 Mustarde's four‐flap technique, 5 lazy S‐plasty, 6 and the skin redraping method 7 . However, most techniques include a complex design, which may lead to increased scarring of the epicanthal area.…”

Section: Introductionmentioning

confidence: 99%

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Dual‐plane epicanthoplasty in Chinese blepharoplasty

Mao

Zhou

et al. 2020

J of Cosmetic Dermatology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dual‐plane epicanthoplasty in Chinese blepharoplasty

Mao

Zhou

et al. 2020

J of Cosmetic Dermatology

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“…Hirohiko et al and Yulan et al verified that the preseptal orbicularis muscle was the anatomical etiologic factor of the epicanthus in their anatomical examination. 11,12 Hirohiko et al found that the preseptal orbicularis fasciculi ran obliquely around the epicanthus and coincided with the direction of the epicanthus in their anatomical study. They also reasoned that the epicanthus formation depended on the intermuscular fibers of the oblique direction of the preseptal orbicularis muscle.…”

Section: Evolution Of the Epicanthus (Kwon's Theory): Etiology And Prmentioning

confidence: 91%

Reconsideration of the Epicanthus: Evolution of the Eyelid and the Devolutional Concept of Asian Blepharoplasty

Kwon

Nguyen

2015

Seminars in Plastic Surgery

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Double eyelidplasty is the most frequent cosmetic procedure for Asians; however, the epicanthus has been a conundrum that limits the cosmetic results of a double eyelidplasty. A double eyelidplasty without epicanthoplasty tends to be unattractive or unnatural. Aesthetically, the epicanthal fold is worsened when performing double eyelidplasty without epicanthoplasty because double eyelid formation aggravates the vertical tension on epicanthal skin. It has been a longstanding dilemma for plastic surgeons as to which procedure to choose: an infold-type double eyelidplasty with a less satisfactory result or an outfold-type double eyelidplasty with concomitant epicanthoplasty with the risk of a hypertrophic scar on the Asian eyelid. When the epicanthal fold is severe, the surgical incision for a skin flap also becomes longer; a scar can be easily visible in the conventional method, which is based on the concept of a local skin flap and lacks a consideration of the upper orbicularis muscle and vertical epicanthal tension.Although it has been reasoned that combined epicanthoplasty is helpful in Asian double eyelidplasty, there has not been a clear understanding of the epicanthal fold, promoting treatment controversy. Early on, many epicanthoplasty methods were developed, mostly based on the skin flap concept. Current methods include combined techniques such as skin excision, Z-plasty, myotomy or myectomy of preseptal orbicularis muscle, skin redraping, plication of medial canthal ligament, and so on.1-5 However, the development of incomplete methods has been unavoidable due to a lack of understanding of the true nature of the epicanthus. As the clinical significance of the epicanthus is mainly related to an Asian double eyelidplasty, an essential epicanthoplasty should be undertaken for all types of double eyelid surgery including the high outfold type (parallel type). But there has not yet been an effective epicanthoplasty method that provides a universal solution for an Asian double eyelidplasty. Our approach addresses the formative causes of epicanthal deformity and their relationship with the double eyelid. Keywords► eyelid evolution ► epicanthus ► epicanthoplasty ► double eyelid ► double eyelidplasty ► Asian blepharoplasty Abstract Double eyelidplasty is the most frequent cosmetic procedure for Asians; however, the epicanthal fold has been a conundrum that has limited the cosmetic results of Asian blepharoplasty. To achieve satisfactory results in an Asian double eyelidplasty, the key is an understanding of the true nature of the epicanthus. We propose that the epicanthus developed in the eyelid's evolutionary process. Selective detachment and superomedial reposition of the preseptal portion of the upper orbicularis muscle can resolve the primary cause of epicanthal formation without functional impairment. The vertical skin shortage and resultant skin tension of the upper eyelid can be corrected by subcutaneous dissection and transverse advancement of skin flap. An epicanthoplasty is part of the core surgery for A...

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“…Various modifications of the Z-plasty technique have been described and all claim excellent results. Examples include the modified Z-plasty [9,11,15,16,22], lazy S technique [19], discrepant Z-plasty [17], and multiple Z-plasty [18]. It is important to note that subcutaneous tissue dissection and orbicularis oculi myectomy is performed in all later publications.…”

Section: Z-plasty and Its Modificationsmentioning

confidence: 97%