Revisional Medial Epicanthoplasty Using Reverse Z-Plasty Technique.

Abstract

Medial epicanthoplasty is a common method for correcting epicanthal folds in Asians but sometimes cause unsatisfactory results. Although several procedural variations have been devised, revision techniques have earned little attention. The revision technique the authors have developed employs reverse Z-plasty to restore an overcorrected epicanthal fold. The aim of this study was to investigate the effectiveness of the authors' reverse Z-plasty technique in restoring natural medial canthal region harmonizing with Asian face. From January 2010 to December 2016, reverse Z-plasty was performed in patients seeking revisions after previous medial epicanthoplasties. Patients were surveyed to assess their satisfaction with surgical outcomes. Interepicanthal distance-lengthening ratios and symmetry of palpebral widths were evaluated digitally (ImageJ software) in patients who received revisional epicanthoplasty only. The reverse Z-plasty technique for revisional epicanthoplasty was performed in 548 Asian patients (83 males, 460 females). Most patients were pleased with the final outcomes. Only 6% submitted to later revisions of scars, which were otherwise scarcely visible after 3 months. Among 60 patients who underwent only revisional epicanthoplasty, interepicanthal distance-lengthening ratios ranged from 2.9% to 31.1% (average, 8.6%), and palpebral width symmetries improved. This particular technique helps restore the 3-dimensional appearance of medial canthal angle through horizontal skin and soft tissue (including muscle and ligament) restructuring, thus compensating for tissue deficiency. It is simple in design, easy to perform, and satisfactory results were achieved, conferring natural aesthetics to the medial canthal region.