Epicanthoplasty with Modified “Y-V”

Epicanthoplasty with Modified “Y-V” Advancement Procedure Abstract The presence of epicanthal folds and lack of supratarsal folds are unique features in most of Asian eyelids.

There are many surgical procedures designed to eliminate epicanthal folds. However, scarring on medial canthus is the main obstacle for surgeons to overcome. From 1989-1 to 1997-11, we used modified “Y-V” advancement procedures to correct epicanthal folds in Asian eyelids in 148 cases.
Five cases of them are congenital palpebral anomalies including congenital entropion, congenital ptosis and Down syndrome. Neither lacrimal apparatus injury nor asymmetry of the eyes was noted.
One case received revision surgery because of resultant unnatural supratarsal fold.
One case received intralesional injection of triamcinolone six months after operation for epicanthal hypertrophic scar.
We thought that the modified “Y-V” advancement procedure could make least scarring on medial canthus in correcting Oriental epicanthal folds and congenital palpebral anomalies. It can be also combined with blepharoplasties and corrective procedures of eyelids simultaneously.
Introduction Creation of a supratarsal fold is the most frequent procedure performed in cosmetic surgery in Orientals.
However, the presence of epicanthal fold weakens the surgical result. Many surgeons persuaded patients to accept their presence in order not to risk the scarring on medial canthus by epicanthoplasty.
Ree and Wood-Smith1 reported that operations to correct the epicanthal fold can be fraught with problems and may result in unsightly scarring of the eyelids.
Park2 classified medial canthus into four types (Fig. 1). Most of the Oriental eyelids with a supratarasal fold fall into type III.
Fernandez3 summarized that 50% of all Orientals lacked a supratarsal fold. Though the incidence of epicanthal fold is not known, we found most of Orientals has an epicanthal fold of varying prominence whether a supratarsal fold is present or not.
Many methods had been mentioned to correct congenital epicanthus in literature.
Some of them are too extensive to correct the Asian epicanthal folds and result in unsightly scar. Several techniques unique for Asian epicanthal folds had been designed. The late Dr. Junichi Uchida14 introduced his spilt V-W plasty in 1962, which is still popular in epicanthoplasty in Oriental eyes.
Flowers15 modified Uchida’s technique and Matsunaga16 used a modified “M”plasty to correct the epicanthal folds.
Fuente17 created a transposition flap whose base, in the medial canthal region, is taken from the posterior surface of the epicanthal fold.
Jordan18 did not remove skin over the epicanthal fold. He removed excessive underlying muscle beneath the fold and attaching the skin edges with “a deep tissue approach” .
Yoon19 modified the Mustard’e technique as so called “one-armed jumping man incision” . Wu20 used the idea of square-flap method21 to correct the epicanthal folds.
Park2 used Z-epicanthoplasty, which was similar to the way Fuente introduced. Materials and Methods From 1989-1 to 1997-11, we had performed the extended Y-V epicanthoplasty in one hundred and forty eight cases. The age ranged from 4 years to 59 years, averaged 27.3 years. (Table I) The follow-up period was ranged from one month to 7 years.
The indications of extended Y-V epicanthoplasty are presence of epicanthal web and 1) widened distance between the eyes (greater than 3.5 cm); 2) congenital ptosis; 3) congenital entropion; 4) telecanthus.
Among the 148 cases, 143 cases received the procedure for correcting Oriental epicanthal folds and 5 of them, for congenital palpebral anomalies. 12 cases received extended Y-V epicanthoplasty alone.
In the other 135 cases, other aesthetic procedures were combined with extended Y-V epicanthoplasty. The detailed data was shown on Table II.
Epicanthoplasty with Modified “Y-V” Advancement Procedure Abstract The presence of epicanthal folds and lack of supratarsal folds are unique features in most of Asian eyelids. There are many surgical procedures designed to eliminate epicanthal folds.
However, scarring on medial canthus is the main obstacle for surgeons to overcome. From 1989-1 to 1997-11, we used modified “Y-V” advancement procedures to correct epicanthal folds in Asian eyelids in 148 cases.
Five cases of them are congenital palpebral anomalies including congenital entropion, congenital ptosis and Down syndrome.
Neither lacrimal apparatus injury nor asymmetry of the eyes was noted. One case received revision surgery because of resultant unnatural supratarsal fold.
One case received intralesional injection of triamcinolone six months after operation for epicanthal hypertrophic scar.
We thought that the modified “Y-V” advancement procedure could make least scarring on medial canthus in correcting Oriental epicanthal folds and congenital palpebral anomalies. It can be also combined with blepharoplasties and corrective procedures of eyelids simultaneously. Introduction Creation of a supratarsal fold is the most frequent procedure performed in cosmetic surgery in Orientals. However, the presence of epicanthal fold weakens the surgical result.
Many surgeons persuaded patients to accept their presence in order not to risk the scarring on medial canthus by epicanthoplasty.
Ree and Wood-Smith1 reported that operations to correct the epicanthal fold can be fraught with problems and may result in unsightly scarring of the eyelids. Park2 classified medial canthus into four types.
Most of the Oriental eyelids with a supratarasal fold fall into type III. Fernandez3 summarized that 50% of all Orientals lacked a supratarsal fold. Though the incidence of epicanthal fold is not known, we found most of Orientals has an epicanthal fold of varying prominence whether a supratarsal fold is present or not.
Many methods had been mentioned to correct congenital epicanthus in literature.4-13. Some of them are too extensive to correct the Asian epicanthal folds and result in unsightly scar. Several techniques unique for Asian epicanthal folds had been designed.
The late Dr. Junichi Uchida14 introduced his spilt V-W plasty in 1962, which is still popular in epicanthoplasty in Oriental eyes. Flowers15 modified Uchida’s technique and Matsunaga16 used a modified “M”plasty to correct the epicanthal folds.
Fuente17 created a transposition flap whose base, in the medial canthal region, is taken from the posterior surface of the epicanthal fold.
Jordan18 did not remove skin over the epicanthal fold. He removed excessive underlying muscle beneath the fold and attaching the skin edges with “a deep tissue approach”.
Yoon19 modified the Mustard’e technique as so called “one-armed jumping man incision”.
Wu20 used the idea of square-flap method21 to correct the epicanthal folds.
Park2 used Z-epicanthoplasty, which was similar to the way Fuente introduced. Materials and Methods From 1989-1 to 1997-11, we had performed the extended Y-V epicanthoplasty in one hundred and forty eight cases.
The age ranged from 4 years to 59 years, averaged 27.3 years.
The follow-up period was ranged from one month to 7 years. The indications of extended Y-V epicanthoplasty are presence of epicanthal web and
1) widened distance between the eyes (greater than 3.5 cm); 2) congenital ptosis; 3) congenital entropion; 4) telecanthus. Among the 148 cases, 143 cases received the procedure for correcting Oriental epicanthal folds and 5 of them, for congenital palpebral anomalies.
12 cases received extended Y-V epicanthoplasty alone. In the other 135 cases, other aesthetic procedures were combined with extended Y-V epicanthoplasty.