Simple Epicanthoplasty with Minimal Scar

Abstract

This article makes for interesting reading about a technique that is easy to follow and perform. However, I am not sure that the concept is entirely original. I have performed a similar technique for the past 5 years, taught to me by a Japanese doctor, Dr Keizo Fukuta of Nagoya [1]. The sole difference is that with Dr. Fukuta s technique (Fig. 1a and b), the tiny triangular skin flap is taken from the terminal part of the epicanthic fold below the level of the horizontal limb and rotated 90 horizontally, whereas with the reported technique, the flap is derived from the skin above the level of the horizontal limb. This is a useful modification because it attempts to blend the vertical limb of the scar into the double-eyelid fold. However, judging from the photographs provided, it may not confer as powerful a correction of the epicanthic fold as the Fukuta technique. With the latter technique, the vertical limb may sometimes be visible as a scar over the medial aspect of the lower lid, but the correction is significant and lasting (Fig. 2a d). Whatever the case, both procedures are cosmetic improvements over the traditional techniques used for epicanthal correction, for which visible scarring has always been a problem. However, I believe the article perpetuates some stereotyping and conceptual misperceptions of the Asian eyelid that need to be corrected because westernization of the Asian eye is not a uniform goal of those seeking cosmetic improvement of the upper lid. Not all Asian eyelids are characterized by thick upper eyelid skin and orbicularis oculi muscle, excessive fat distributed between the orbicularis oculi muscle and the levator palpebrae muscle, laxity of the pretarsal fold and absence of supratarsal folds due to lack of levator palpebrae attachments to supratarsal skin, and the presence of a medial epicanthal fold (Fig. 3). Almost all Asians have some form of epicanthic fold whether there is an accompanying double-eyelid crease or not. When present, the double-eyelid crease or palpebral fold exists in two forms: an ‘‘innie’’ (in which the crease blends medially with the epicanthic fold; Fig. 4a and b) or an ‘‘outie’’ (in which the fold runs parallel with the lid margin; Fig. 5a and b). Some individuals may have an ‘‘innie’’ on one side and an ‘‘outie’’ on the other side (Fig. 6). This palpebral fold in the Asian upper eyelid is a true ‘‘double’’ eyelid because it is a pretarsal crease caused by folding of the pretarsal skin and not just a supraorbital hollow or sulcus (Fig. 7a), which characterizes many Caucasian lids. This latter Correspondence to W. Wu, M.D.; email: woffles@ woffleswu.com Fig. 1. (a) Fukuta technique, preoperative markings. (b) Fukuta technique, postoperative diagram of flap rotation. Aesth. Plast. Surg. 31:354 357, 2007 DOI: 10.1007/s00266-006-0205-6