Revisiting Anchor Epicanthoplasty in Mild to Moderate Asian Epicanthal Folds: A Clinicopathological Study.

Abstract

To assess the epicanthal fold (EF), eyelid, eyebrow, scar, and patients' satisfaction after anchor epicanthoplasty and upper blepharoplasty and histopathologically compare Asian epicanthal fold skin with non-Asian counterpart. Asian Iranians with grade 2 and 3 EF were included. Photographs were taken before and at least 12months after the surgery. Photoanalysis included EF grade, inter-canthal distance (ICD), margin reflex distance 1 (MRD1), tarsal plate show (TPS), brow fat span (BFS), and eyebrow height. Manchester scar scale score (5-28) and patients' satisfaction score (0-100) were documented. The most medial skin of 5 Asian and 5 non-Asian subjects was histologically compared for the thickness and elastic fiber density and morphology. Included were 89 patients (178 eyelids) with a mean age of 31.6years and follow-up of 13.1months. Mean ICD significantly decreased by 3.5mm (shortening ratio of 9.7%). All grade 2 and almost half of the grade 3 EF disappeared. Significant postoperative increase in mean MRD1 (0.3mm) and TPS (1.1-1.4mm) and decrease in BFS (3.3-3.6mm) and eyebrow height (1.7-3.4mm) were observed. Revision rate of epicanthoplasty was 7.3%. Mean satisfaction and scar scores were 97.1 and 5.4, respectively. Histopathologically, Asian and non-Asian medial upper eyelid skin was not significantly different. Anchor epicanthoplasty eliminated grade 2 and improved grade 3 EF with a high satisfaction and negligible scar. Simultaneous upper blepharoplasty significantly increased MRD1 and TPS and decreased eyebrow height. EF skin was not histologically different from non-Asians. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .