Modifications of Z-Epicanthoplasty Combined with Double-Eyelid Blepharoplasty in Asians.

[BACKGROUND] Epicanthoplasty combined with double-eyelid blepharoplasty is one of the most popular cosmetic procedures in Asians. However, the postoperative medial canthal scar is a concerned issue. Here the authors adopted some modifications of Z-epicanthoplasty to minimize the canthal scar.

[METHODS] Modifications of Z-epicanthoplasty were mainly in three aspects. First, supratarsal creases were created before epicanthoplasty to prevent the impact of tension variation on epicanthal incisions, caused by elevating and tightening of the upper eyelid skin. Second, one triangle flap was determined according to the transposition of another one in Z-plasty, and hence, it can be guaranteed that the incisions were closed free of tension with more accuracy and less injury to surrounding tissues. Third, linear scar contracture was avoided by adopting discontinuous incisions, and the resulting skin bulge was eliminated by making an additional stitch to anchor the pretarsal skin on the tarsal plate. The follow-up interval was 1 month to 2 years, with a median of 6.5 months.

[RESULTS] From January 2012 to December 2015, 237 female and 4 male patients received the surgery. Except five (2.07%) patients, who were not satisfied with the color of incision scars in medial canthal area, none complained about scars 6 months after surgery. The appearance of the supratarsal crease was natural, and the medial canthal scar was inconspicuous in close observation at 2 years.

[CONCLUSION] The modifications of Z-epicanthoplasty are safe and effective. It is potentially helpful to minimize postoperative medial canthal scars.

[LEVEL OF EVIDENCE IV] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .