Dual-plane epicanthoplasty in Chinese blepharoplasty

Background: The ethnically characteristic upper eyelids of many Chinese individuals include medial epicanthal folds, substantial fatty tissue, a laxity of pretarsal skin, and a lack of superior palpebral folds. Different epicanthoplasty techniques have been described in the literature. However, postoperative medial canthal scarring remains a concern.

Objectives: This article introduces a novel technique that minimizes the risk of postoperative canthal scarring.

Methods: Dual-plane epicanthoplasty involves an advanced skin flap and a rotation skin flap, which are, respectively, distributed on the outer skin lining and inner skin lining and belong to the different three-dimensional planes of the epicanthus. The dense connective fibers located between the skin and the orbicularis oculi muscle were completely released. In the final steps, the upper advanced triangle flap was anchored in the direction of the lacrimal caruncle and the lower rotation triangular flap was anchored to the nasal skin.

Results: From January 2016 to September 2018, 216 patients were enrolled in the cohort undergoing dual-plane epicanthoplasty, with 172 patients undergoing the concomitant double eyelidplasty. For 206 of the cases, follow-up lasted for over 6 months, with a median time of 11 months. Except for one patient (0.49%) who may need a revision procedure for a prominent scar, all other patients (99.51%) achieved natural and cosmetically desirable appearances with adequate lacrimal caruncle exposure and minimal postoperative medial canthal scaring.

Conclusion: Dual-plane epicanthoplasty, with or without double eyelidplasty, is a novel and effective surgical technique modified for Chinese patients with good esthetic outcomes.