Asian Blepharoplasty III: Factors that Influence Outcome

Optimal Crease Design

It is my experience that the nasally tapered crease is slightly easier to achieve surgically than the parallel crease. Most Asians who are not born with a crease have a medial canthal fold, to a varying degree. It is therefore not necessary in the design of a nasally tapered crease to excise the entire medial fold, but sufficient to reduce it and allow the crease's infolding to merge into a much-reduced medial fold of skin.

For a patient who wants a parallel crease, a more thorough reduction of the medial canthal fold needs to be carried out: this includes skin and subcutaneous tissues such that webbing does not result, or inadequate crease formation at the medial end of the crease. Special anchoring of the medial end of the crease to retain the parallel nature of the crease may be necessary.

Epicanthoplasty

The term medial epicanthoplasty is often mentioned in conjunction with Asian eyelid surgery and reflects surgeons' concern that construction of the crease alone will be inadequate. The source of the term was in connection with abnormal epicanthus inversus seen in blepharophimosis patients or those with trisomy syndromes. The surgical solutions often involved complicated V–Y-plasty or W-plasty with multiple steps in a patient with congenital abnormalities (like telecanthus) if not treated, and therefore the surgical scars might be the lesser of two evils. If true epicanthoplasty as described in those original papers for these abnormal conditions were to be performed in an otherwise normal Asian, the probable risk for visible scar would be much greater than any possible benefits gleaned, since often the small fold can be handled easily through excision of the skin fold that overlaps while closing the medial end of an Asian blepharoplasty. Most surgeons, including the present author, are aware of this and simply perform the reduction of the fold, not evoking the word ‘epicanthoplasty’ for these small steps. The few that actually perform or promote the whole procedure risk leaving their patient with a noticeable scar. Those that perform small trimming but nonetheless call the procedure ‘medial epicanthoplasty’ are using the term in a very broad sense and are probably perpetuating misinformation among patients and confusing surgeons alike.