Invisible scar medial epicanthoplasty: A novel approach

Background: Presently, many techniques have been described to make the epicanthal fold less prominent. However, visible scarring remains a major concern in most techniques. The aim of this study was to develop a novel design using concealed incisions with minimal tension.

Methods: Between December 2010 and May 2015, charts were reviewed from patients who underwent a concealed incision and tension-free technique to correct the epicanthal fold. The intercanthal distance (ICD), interpupillary distance (IPD), scar visibility, and cosmetic results were evaluated preoperatively and 1 year after the surgery. The ratio of the ICD to IPD (ICD ratio) was calculated, and the visibility of the scar was assessed.

Results: In total, 136 patients (mean age 25.2 ± 2.7 years, range 20-32 years) were included. The preoperative median ICD ratio was 0.60 (range, 0.54-0.68) and decreased to 0.54 (range, 0.48-0.62) postoperatively. The median ICD ratio reduction was 9.1% (range, 3.6%-22.0%; P < 0.001, Wilcoxon signed-rank test). One hundred and thirty-four patients (98.5%) had no visible scarring or minimal scarring visible only under close inspection. Two patients (1.5%) experienced a more prominent scar, but none of them developed a severe scar requiring revision. The aesthetic outcome judged by the patient and surgeon was excellent or good in all cases.

Conclusions: From our experience, the scar after medial epicanthoplasty can be minimized by using a concealed incision and tension-free technique. Our technique is an effective and individualized method, leading to a high satisfaction rates.