Z-epicanthoplasty in Asian eyelids.

The creation of a supratarsal fold is the most frequently performed cosmetic surgical procedure in Asia. The presence of epicanthal folds in Asian eyelids is one of their unique features, in combination with the lack of supratarsal folds. While this represents an element of Oriental beauty in a traditional way, many seek cosmetic improvement in the medial canthal area to eliminate the epicanthal fold. Epicanthoplasty enhances the aesthetic result of the double-lid procedure by lengthening the palpebral fissure, thus producing the image of a larger, open eye. I present a simple, easily reproducible method of Z-epicanthoplasty based on my experience with 160 cases performed during the past 21 months on Asian eyelids. The advantages of this procedure are simplicity in design and minimal scarring produced in the medial canthal area as compared with complex W-plasty, which requires multiple incisions and often creates unsightly scarring.