“Asian epicanthoplasty by realigning the misaligned medial canthal corner with the anatomical medial canthus point through triangular incisions”

SUMMARY: The incidence of epicanthal fold (EF) is extremely high in Asians. It is proposed that the medial canthal corner and the anatomical medial canthus point have a distinct alignment, which may explain the underlying mechanism for EF development. Accordingly, a method is proposed for repositioning the misaligned superficial and deep layers of the medial canthus through tiny incisions to remove Asian EF. The surgery started with a small triangular incision as the first step. The superficial fibers of the medial canthal ligament and the malpositioned fibers of the orbicularis oculi muscle were released. To reposition and realign the medial canthal corner, which has a distinct alignment compared to the anatomical medial canthal point, we transposed and refixed these distally severed muscle fibers and fibrotic tissue along with the skin flap to the deep medial canthal ligament. Aesthetic outcomes were assessed by scar visibility, complication rates and patient satisfaction. From January 2020 to May 2023, 298 patients with or without blepharoplasty underwent epicanthoplasty using this technique. Postoperative follow-up was 6-36 months. Postoperatively, 265 (88.9%) patients had no obvious scarring, 30 (10.1%) had minimal scarring visible only under close inspection, and 3 (1.0%) had visible scarring. Notably, no patients had severe scarring requiring revision. Ninety-eight percent of patients were generally satisfied with their surgical outcomes and presented well-defined double eyelids and naturally improved medial canthus contours. The introduced method is simple in design and effectively improves EF in Asians, resulting in a natural eyelid appearance.