A Modified and Accurately Designed Z-Epicanthoplastic Technique

Surgical creation of a supratarsal crease has been by far the most common cosmetic procedure in China. To gain a pleasing eye appearance, double-eyelid surgery usually is performed in combination with epicanthoplasty. Currently, many epicanthoplastic techniques are described. Essentially, among the various epicanthoplasties, quite a few procedures are different designs of the Z-plastic or Y-V technique. In the authors’ opinion, a better cosmetic result depends on a specific design more than the procedure itself. This report describes a modified Z-epicanthoplastic technique with accurate design and different types of tissue flaps raised. The authors performed epicanthoplasties with the Z-plastic technique for 163 patients from December 2006 to December 2010. Interepicanthal distances longer than a palpebral fissure and lacrimal caruncles obviously covered by epicanthic folds were considered an indication for performing epicanthoplasty. The follow-up period ranged from 4 months to 4 years. A good result was obtained, with natural fine creases of the upper eyelids and complete caruncle exposure at the near inner canthus. There was no shadow or local depressed deformity, visible scar in the inner canthus, or recurrence, and most of the patients showed slight westernizations of the medial eye architecture rather than wide and prominent western upper eyelid creases at the medial eyelids. Three patients had slight asymmetric exposure of the lacrimal caruncle, which was corrected by a second surgery. In conclusion, the modified and accurately designed Z-epicanthoplasty can avoid some complications such as local depressed deformity, displeasing appearance, and excessive westernized architecture at the inner canthus. A predictable shape in the medial corner can be obtained by developing and accurately designing different types of flaps.