Medial Epicanthoplasty: A Modified Inverted Z-Plasty Technique to Create Ethnic Appropriate Medial Canthal Configuration.

backgroundThe medial epicanthal fold is a common anatomical feature in Asian populations, often coexisting with single eyelid configurations. Epicanthoplasty, combined with blepharoplasty, is a standard cosmetic procedure to create a larger palpebral fissure, yet achieving optimal outcomes with undetectable scarring and preserved canthal function remains challenging. This study develops an advanced inverted Z-plasty technique incorporating biomechanical principles to achieve superior ethnic aesthetics and inconspicuous scarring through minimal tissue disruption.

methodsFrom February 2022 to June 2025, 17 patients, comprising 15 females and two males, underwent a novel epicanthoplasty technique. The age distribution of the patients ranged from 17 to 46 years. The severity of the epicanthal fold was categorized into three grades: mild, moderate, and severe. Specifically, 3 cases were classified as mild, eight as moderate, and six as severe. A modified inverted Z-plasty technique, incorporating medial canthal tendon (MCT) folding, was utilized to correct the medial epicanthal fold, which was performed concurrently with double eyelid surgery. Postoperative follow-up ranged from 3 to 39 months, averaging 18.5 months. Scar quality was assessed using the Vancouver Scar Scale (VSS). Aesthetic outcomes were evaluated using patient-reported visual analog scale (VAS) scores.

resultsThe modified inverted Z-plasty technique demonstrated excellent outcomes in 17 Asian patients, with all cases achieving imperceptible scarring (VSS score ≤ 1). Postoperatively, all patients exhibited a notable improvement in their epicanthal folds. The mean visual analog scale (VAS) score was 4.8 (4.5-5.0). Biomechanical modifications effectively widened the palpebral fissure to achieve an aesthetic outcome consistent with Asian preferences, while simultaneously ensuring the complete preservation of lacrimal lake function, resulting in 100% patient satisfaction. All observed complications were transient and well-tolerated.

conclusionThe modified inverted Z-epicanthoplasty demonstrates safety and efficacy in medial epicanthal fold correction across varying severity grades, delivering aesthetically durable, ethnic-appropriate results with clinically invisible scarring. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .