Epicanthal Fold Reconstruction Using V-Y Advancement and Triangular Flap

BACKGROUND: Epicanthoplasty is frequently performed in Asian populations, but overcorrection-resulting in undesirable aesthetic and functional outcomes-remains a persistent challenge. PURPOSE: This study investigates the efficacy of a novel technique combining V-Y advancement with a triangular flap for reconstructing iatrogenic overcorrection of epicanthal folds, with emphasis on anatomic precision and individualized aesthetic restoration. METHODS: 19 patients with overcorrection secondary to prior blepharoplasty underwent bilateral reconstruction using the proposed technique. Meticulous anatomic markings guided the V-Y advancement and triangular transposition flap to correct tissue deficiencies. Preoperative and postoperative (1-week and 1-month) medial canthal angles were quantitatively analyzed using standardized imaging and software. We also administered standardized surveys at 1-month (n = 19), 3-month (n = 15), and 6-month (n = 12) intervals following epicanthal fold reconstruction. RESULTS: The medial canthal angle significantly increased from 55.94 ± 5.12° preoperatively to 58.63 ± 2.80° at 1 month postoperatively ( P = 0.026), confirming successful anatomic reconstruction. Longitudinal analysis revealed sustained enhancement in satisfaction rate at 6 months (58.3% very satisfied, 41.7% satisfied). The technique consistently improved lacrimal caruncle coverage, refined the medial canthal contour, and reduced medial double-eyelid width, eliminating the need for secondary revisions in most cases. CONCLUSION: The integrated V-Y advancement and triangular flap technique offers a reliable and adaptable solution for addressing epicanthal fold overcorrection, effectively balancing functional and aesthetic demands. Long-term studies with objective morphometric analyses are essential to further establish its clinical utility.