Background: Patients with no double eyelid folds and with a mild or moderate medial epicanthus are most typically Asians. After only receiving double eyelidplasty, they often complain that their eyes look round and their eyelid fissures are shorter because their medial epicanthi still exist.
Methods: In this article, according to the authors' surgical findings, it is reasoned that the malpositioned portion of the orbicularis oculi muscle fibers is the main cause of congenital medial epicanthus. Several design principles for performing the Z-epicanthoplasty concomitant with a double eyelidplasty were advanced: (1) removal of the main deformity-formed cause, (2) correcting the pretarsal skin shortage in the medial upper eyelid, (3) preventing the prominent scarring in the medial canthal area, and (4) achieving other advantages (i.e., easy design and operation, precision of performance with a concomitant double eyelidplasty, and excellent and reproducible results).
Results: Epicanthoplasty only was performed in six patients. An epicanthoplasty concomitant with a double eyelidplasty was performed in 230 cases with congenital or traumatic medial epicanthi. Sixty-seven cases in this series were followed up for 4 to 23 months (average, 7 months). The contours of the double eyelids were natural. Mild scar proliferation was observed in all of the patients in the early postoperative period and then would diminish and become a gray-white line. Some skin wrinkles and skin shadow on the B flap could be seen.
Conclusions: The indications for this procedure are all types of medial epicanthi but the inversus type. Older age is a relative contraindication.