Medial Epicanthoplasty: A Modified Inverted Z-Plasty Technique to Create Ethnic Appropriate Medial Canthal Configuration.

[BACKGROUND] The medial epicanthal fold is a common anatomical feature in Asian populations, often coexisting with single eyelid configurations. Epicanthoplasty, combined with blepharoplasty, is a standard cosmetic procedure to create a larger palpebral fissure, yet achieving optimal outcomes with undetectable scarring and preserved canthal function remains challenging. This study develops an advanced inverted Z-plasty technique incorporating biomechanical principles to achieve superior ethnic aesthetics and inconspicuous scarring through minimal tissue disruption.

[METHODS] From February 2022 to June 2025, 17 patients, comprising 15 females and two males, underwent a novel epicanthoplasty technique. The age distribution of the patients ranged from 17 to 46 years. The severity of the epicanthal fold was categorized into three grades: mild, moderate, and severe. Specifically, 3 cases were classified as mild, eight as moderate, and six as severe. A modified inverted Z-plasty technique, incorporating medial canthal tendon (MCT) folding, was utilized to correct the medial epicanthal fold, which was performed concurrently with double eyelid surgery. Postoperative follow-up ranged from 3 to 39 months, averaging 18.5 months. Scar quality was assessed using the Vancouver Scar Scale (VSS). Aesthetic outcomes were evaluated using patient-reported visual analog scale (VAS) scores.

[RESULTS] The modified inverted Z-plasty technique demonstrated excellent outcomes in 17 Asian patients, with all cases achieving imperceptible scarring (VSS score ≤ 1). Postoperatively, all patients exhibited a notable improvement in their epicanthal folds. The mean visual analog scale (VAS) score was 4.8 (4.5-5.0). Biomechanical modifications effectively widened the palpebral fissure to achieve an aesthetic outcome consistent with Asian preferences, while simultaneously ensuring the complete preservation of lacrimal lake function, resulting in 100% patient satisfaction. All observed complications were transient and well-tolerated.

[CONCLUSION] The modified inverted Z-epicanthoplasty demonstrates safety and efficacy in medial epicanthal fold correction across varying severity grades, delivering aesthetically durable, ethnic-appropriate results with clinically invisible scarring.

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