Experience of Two Different Techniques of Medial Epicanthoplasty with Four-Point Homologous Design: A Cohort Study.

[BACKGROUND] Various methods have been introduced to eliminate the epicanthus; however, there are no clear guidelines to determine the optimal technique for epicanthus. We aimed to investigate the clinical effect of modified Z-plasty and modified Y-V flap on epicanthus and report our experience.

[METHODS] Medical records, including photographic information and scar score, of 81 eyes of 43 patients with congenital epicanthus were collected. All patients underwent epicanthus correction surgery by the modified Z-plasty or modified Y-V flap methods with a four-point design from January 2018 to December 2019 in Shanghai Ninth People's hospital and completed a follow-up of at least 6 months. The cosmetic outcome was evaluated in terms of by photographic evaluation and scar score, and the structural outcome was assessed by intercanthal distance (ICD) and palpebral fissure length, inner canthal angle, the canthal tilt angle. The results of two surgical techniques were compared and analyzed.

[RESULTS] The cosmetic outcome of both group is good in both groups. ICD is smaller and inner canthal angle is larger in modified Z-plasty group, compared to modified Y-V flap group, respectively (P < 0.05). Patients with severe epicanthus in the modified Z-plasty group showed greater improvement in structural outcomes than in the modified Y-V flap group (P < 0.05), while those with mild epicanthus in the modified Y-V flap group showed more improvement in ICD than those in the modified Z-plasty group (P < 0.05). By 6 months, scarring in the modified Z-plasty group was more hypertrophic and obvious compared to the modified Y-V flap group (P < 0.05).

[CONCLUSION] Modified Y-V flap technique caused less scarring. Conversely, the modified Z-plasty technique was more efficient in shortening the ICD and increasing inner canthal angle. While modified Z-plasty reconstruction is more suitable for patients with severe epicanthus, the modified Y-V flap is more suitable for patients with mild epicanthus.

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