Restoration of Complicated Epicanthus: Modified Reverse Skin Redraping With Mini-epicanthoplasty for Rescue in Unsatisfied Epicanthoplasty Patients

Abstract

Purpose: We had reported the surgical outcome of reverse skin redraping technique for restoration of previously performed epicanthoplasty. In this study, we introduce a modified reverse skin redraping technique that added mini-epicanthoplasty in patients with unsatisfactory results after epicanthoplasty.

Methods: Three hundred twenty-four patients (288 female and 36 male patients) who had unsatisfied results with previous epicanthoplasty and that were treated with our modified restoration surgery were included in this study.

Results: The mean preoperative interepicanthal distance was 33.6 mm, and the mean postoperative interepicanthal distance was 36.9 mm; the mean difference in the interepicanthal distance before and after restoration surgery was 3.3 mm. Satisfactory aesthetic results were obtained with improvements in areas of asymmetry, overexposure of the caruncle, and the appearance of the previous scar. Only minor complications developed in 15 patients (4.6%) that were resolved with minor revisions. No severe complications requiring reoperations were noted.

Conclusions: Our modified method involving reverse skin redraping and mini-epicanthoplasty is simple and reproducible and is useful for resolution of unsatisfactory results to obtain a naturally shaped epicanthus.

FIGURE 1

Mark point A at 1 mm medial from the innermost portion of epicanthus, and mark point B at a location 4 mm away and at 70 degrees upward on the upper eyelid (left). Mark point C is at an outer position following the subcilliary line. After drawing a continuous line from B-A-C (a black line), an incision is made using a blade (no. 15). Then, submuscular dissection is performed under the slashed red area (right).

FIGURE 2

The skin flap was pulled to medial nose and point A was shifted medially (upper column). A shifted point became point A’. Point B’ was marked on a line connecting BA with distance of 2.0 to 2.5 mm from point B (lower column).

FIGURE 3

A’B becomes the front side, and BB’ becomes inner side of fold. In a connecting line between BB’, stitches in red circle area (left pictures) were removed for mini-epicanthoplasty.

FIGURE 4

Method of mini-epicanthoplasty. After removal of stitches between BB’ with pulling a skin into medial direction with thumb, B’ is sutured into B that could change the horizontal line (performed removal of stitches between B and B’, red circle in Fig. 3) to oblique line (red arrow of right picture). It can pull medial epicanthus into medial direction that finally result in “pointed epicanthus”(blue arrow). Dash lines in the right picture are schematic illustration of the wound configuration.

FIGURE 5

A 28-year-old man presented with overexposure of caruncle and blunt medial canthal shape after epicanthoplasty (left). Three months postoperative results after modified restoration method (right). The caruncle was no longer exposed, and the blunt canthal angle was restored to a sharp and pointed normal appearance.

FIGURE 6

A 34-year-old woman complicated after epicanthoplasty. Preoperative view—wide and depressed scar with overcorrected epicanthus (left), 6 months postoperative results (right).

FIGURE 7

A 40-year-old woman presented with distorted epicanthal shape after previous epicanthoplasty. Preoperative results—scar widening and overcorrection (left), 3 months postoperative results.