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Posts Tagged ‘epicanthoplasty’

Double Eyelid Surgery with Epicanthoplasty

Tuesday, May 24th, 2016


Double Eyelid Surgery Dr Barry Eppley IndianapolisIn Asian blepharoplasty, more commonly known as double eyelid surgery, the influence of the fold at the inner eye (epicanthus) can affect the aesthetic outcome. As a result many double eyelid surgeries are combined with a medial epicanthoplasty for an improved aesthetic appearance. While the epicanthus is a small structure, there is a large number of operations described for its correction. There does not appear to be a universally agreed upon method for the epicanthoplasty which suggests that all of them have some downside.

Z-Epicanthoplasty Dr Barry Eppley IndianapolisHistorically, some surgeons have avoided epicanthoplasty because of the fear of visible scar formation at the inner eye. But the Z-epicanthoplasty has proven to be a safe and effective technique for eliminating the epicanthal fold during double-eyelid operations without problematic scarring at the medial canthal area. They are numerous small variations of the Z-epicanthoplasty most of which focus on  hiding the scar line in the inner cants area.

In the January 2016 issue of the journal Aesthetic Plastic Surgery, an article was published entitled ‘A Modified Method Combining Z-Epicanthoplasty and Blepharoplasty to Develop Out-Fold Type Double Eyelids’. In this paper the authors describes his technique for combining double eyelid surgery with a Z-epicanthoplasty in over 1100 women. The goals of the surgery was to create a parallel double eyelid fold with an exposed inner canthus and lacrimal caruncle. The upper eyelid incision is carried out to the new inner canthus location and the skin excised. The muscle fibers that adhere to the inner canthal ligament are severed to release any tension on the epicanthal skin flap. A small z-plasty is then performed on the inner canthal skin flaps. The revision rate was eight patients. (less than 1%)

Double Eyelid Surgery and Lower Eyelid Love Band Surgery Dr Barry Eppley IndianapolisThe Asian upper eyelid has a characteristic single fold with an epicanthus and saggy skin. When an epicanthus is not present, a double eyelid surgery alone can suffice. But with an  epicanthal fold present, double eyelid surgery will create a short and narrow double fold appearance. Thus combining double eyelid surgery with an epcanthoplasty is now common practice. This allows for a smooth connection between the double fold eyelid and the inner canthus. The goal of the Z-epicanthoplasty is to relieve the tension on the medial cantonal area which contributes to the epicanthal fold being present and prevent any adverse scarring in this highly visible area.

Dr. Barry Eppley

Indianapolis, Indiana

Medial Epicanthoplasty Techniques Compared

Sunday, June 21st, 2015


epicanthal fold dr barry eppley indianapolisThe Asian eyelid is known to have a lack of a supratarsal fold and the presence of an epicanthal fold. These are unique eyelid features which are the complete opposite eyelid features seen in the non-Asian eyelid. These differences drive some Asians to seek cosmetic improvement through double eyelid surgery and in the inner eye area. Decreasing the prominence of the epicanthal fold, known as a medial epicanthoplasty, has been described by numerous methods. No single epicanthoplasty technique has been determined to be the best although many surgeons clearly have their favorite technique.

In the July 2015 issue of the Plastic Reconstructive and Aesthetic Surgery Journal, the paper ‘Structural and cosmetic outcomes of medial epicanthoplasty: An outcome study of three different techniques’ was published. In this clinical study the authors evaluated the cosmetic outcomes from three different methods of medial epicanthoplasty. (root z-plasty, Y-V plasty and Mustarde’s technique. Studying 46 patients (92 eyes) over three years the change in horizontal fissure width were measured in terms of appearance, symmetry and scarring up to six months after surgery. Root Z-plasty, Y-V plasty, and Mustarde’s method were performed on 64, 13, and 15 eyes respectively. By six months after surgery, the horizontal fissure width increased by an average of 1.74 mm (8 % increase), 1.64 mm (9% increase), and 1.89mm (13% increase), respectively. Root Z-plasty had the higher postoperative appearance grade than the other two methods with the best scar appearance. Symmetry was good for all three methods.

epicanthoplastyAll studied medial epicanthoplasty techniques were able to increase horizontal fissure width. Collectively they did so by just under 2mms. It is interesting that such a small increase in horizontal fissure distance can make such a significant cosmetic improvement.The one distinguishing difference was that the root Z-plasty resulted in the best scar outcomes. Root Z-epicanthoplasty requires a fairly simple design and procedure to perform. It also creates the least amount of incisional lengths which may account for its best scar appearance.

Despite the incredibly small size of the epicanthal fold, reducing its appearance is challenging. It is an eye area that is both highly visible and creates a distinct appearance between the nose and eye. Every epicanthoplasty technique uses very small skin flaps but the risk of overcorrection and hypertrophic and visible scarring is real. It is a procedure that is truly defined by the phrase ‘less is more’ with emphasis on a conservative vs an aggressive approach.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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