The 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.
All 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