The new focus on epicanthoplasty for Asian eyelids.

Abstract

Purpose of review is to emphasize the clinical significance of the epicanthal fold when evaluating Asian eyelids. Advances in Asian eyelid research have improved the understanding of the epicanthal fold and highlighted key steps to performing successful epicanthoplasty. Up-to-date epicanthoplasty surgical techniques are also discussed. The epicanthal fold is common in the Asian population. It is composed of the preseptal part of the orbicularis oculi muscle. Various epicanthoplasty techniques have been described and can be broadly categorized into two types based on the type of skin flap created: the advancement flap and the transposition flap. The skin flap can be created in several ways depending on surgeon preference and the severity of the epicanthal fold but is not the key step in epicanthoplasty. Releasing all vertical tension by subcutaneous tissue dissection and orbicularis oculi myectomy are the main surgical steps to successful correction. Earlier described epicanthoplasty methods created obvious scarring, under correction, and recurrent deformity. Newer techniques offer improvements with a shorter skin incision, smaller flap creation, and minimal or no medial canthal ligament plication to lessen wound tension. For optimal surgical results in Asian upper eyelid surgery, presence of the epicanthal fold and surgical correction options should be discussed primarily.