Research progress in repair of post-epicanthoplasty deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

REN Boyang , CHEN Wen

Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P. R. China;

Corresponding?author：

CHEN Wen, Email:

Keywords：

Epicanthal fold; post-epicanthoplasty deformity; medial canthal repair

DOI：

10.7507/1002-1892.202509071

Video：

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Objective To provide a comprehensive review of the surgical methods for repairing post-epicanthoplasty deformity, aiming to offer a reference for clinical decision-making in selecting appropriate techniques. Methods Relevant research literature concerning the repair of post-epicanthoplasty deformities was extensively reviewed. The background, clinical applications, and current challenges of these reconstructive procedures were summarized and analyzed. Results Post-epicanthoplasty deformities are not uncommon, and with evolving aesthetic standards, the demand for medial canthal reconstruction is increasing. The primary surgical techniques reported in the literature include the V-Y advancement flap, the reverse skin-redraping method, and the reverse Z-plasty. In recent years, the application of orbicularis oculi myocutaneous flaps has become more prevalent. While most of these procedures yield satisfactory outcomes, they still face certain limitations, particularly in addressing challenges related to scar management, individual patient variations, and the precise control of medial canthal morphology. Conclusion When clinically addressing post-epicanthoplasty deformities, surgeons must select the most suitable surgical method based on a comprehensive assessment of the patient’s specific condition and various contributing factors. An individualized approach is crucial to achieving the optimal aesthetic and functional outcomes.

1.	劉暢, 王太玲. 內眥贅皮診療研究進展. 中華整形外科雜志, 2021, 37(12): 1397-1403.
2.	Saonanon P. The new focus on epicanthoplasty for Asian eyelids. Curr Opin Ophthalmol, 2016, 27(5): 457-464.
3.	王詩萌. 內眥纖維帶在亞洲人中、重度內眥贅皮成因及臨床應用研究. 長春: 吉林大學, 2023.
4.	Fakhro A, Yim HW, Kim YK, et al. The evolution of looks and expectations of Asian eyelid and eye appearance. Semin Plast Surg, 2015, 29(3): 135-144.
5.	Tong J, Wang R, Sun J, et al. Modified Z-epicanthoplasty based on the movement and tension of medial canthal area in Asian females. J Craniofac Surg, 2021, 32(6): 2198-2201.
6.	Lyu D, Jin Y, Chang L, et al. The Modified Z-epicanthoplasty-a stepwise and individualized design. Ann Plast Surg, 2017, 78(1): 7-11.
7.	Zan T, Jin R, Li H, et al. A novel U-flap epicanthoplasty for Asian patients. Aesthetic Plast Surg, 2016, 40(4): 458-465.
8.	Zhang S, Xue H. Upper arch flap combined with extended incision of lower eyelid: A modified epicanthoplasty in correcting epicanthus. Aesthetic Plast Surg, 2018, 42(4): 1033-1038.
9.	Xie A, Cao Y, Yu D. Combined transverse incision and pouch incision for the correction of medial epicanthus. J Craniofac Surg, 2019, 30(5): 1499-1502.
10.	Oh J, Lee K. Medial lower lid epiblepharon repair solely by skin-redraping medial epicanthoplasty. Br J Ophthalmol, 2014, 98(10): 1437-1441.
11.	Liu HP, Zhao YY, Li B, et al. The orbicularis oculi muscle resection technique for medial epicanthoplasty: A retrospective review of surgical outcomes in 47 Chinese patients. J Plast Reconstr Aesthet Surg, 2017, 70(1): 96-103.
12.	Sun W, Yin N, Song T, et al. A practical technique combining orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty. J Plast Reconstr Aesthet Surg, 2019, 72(12): 2009-2016.
13.	Kiranantawat K, Suhk JH, Nguyen AH. The Asian eyelid: Relevant anatomy. Semin Plast Surg, 2015, 29(3): 158-164.
14.	McCurdy JA. Beautiful eyes: characteristics and application to aesthetic surgery. Facial Plast Surg, 2006, 22(3): 204-214.
15.	Li Z, Zhang S, Yu J, et al. Double eyelid shape preference: A large sample survey. Aesthetic Plast Surg, 2022, 46(5): 2287-2294.
16.	Hwang HS, Spiegel JH. The effect of “single” vs “double” eyelids on the perceived attractiveness of Chinese women. Aesthet Surg J, 2014, 34(3): 374-382.
17.	王成源, 呂唯, 莊巖, 等. 中國人對內眥贅皮的美學認知調查. 中國美容整形外科雜志, 2015, 26(7): 407-410.
18.	Shin YH, Hwang PJ, Hwang K. V-Y and rotation flap for reconstruction of the epicanthal fold. J Craniofac Surg, 2012, 23(4): e278-280.
19.	Kim J, Kim J, Kim J, et al. Autologous tissue graft in revision medial epicanthoplasty using subciliary fat and orbicularis oculi muscle. J Craniofac Surg, 2017, 28(8): 1972-1975.
20.	Lee TY, Shin YH, Choi DI. Reconstruction of medial epicanthal fold using V-Y advancement and turnover flap. J Plast Reconstr Aesthet Surg, 2020, 73(2): 363-368.
21.	石海山, 劉海蘭, 劉輔容, 等. 一種修復內眥贅皮矯正術后形態不良的新方法. 中華整形外科雜志, 2023, 39(10): 1094-1099.
22.	潘貳, 王布霖, 于建剛, 等. 眼輪匝肌肌皮瓣V-Y成形術修復內眥過大畸形. 中華整形外科雜志, 2022, 38(11): 1283-1288.
23.	Xu L, Wang H, Ma T, et al. Reconstruction of medial epicanthal fold using dual-plane V-Y advancement flap. Aesthetic Plast Surg, 2025, 49(10): 2727-2734.
24.	Chung YJ, Kong JS, Kim YW, et al. Restoration of the medial epicanthal fold: reverse skin redraping method in patients unsatisfied with epicanthoplasty. Ann Plast Surg, 2013, 71(5): 456-460.
25.	Chung YJ, Han KE, Park BY. Restoration of complicated epicanthus: Modified reverse skin redraping with mini-epicanthoplasty for rescue in unsatisfied epicanthoplasty patients. Ann Plast Surg, 2017, 78(6): 613-617.
26.	Chung YJ, Park BY. Reoperation of epicanthal reconstruction using a modified reverse skin-redraping method. Medicine (Baltimore), 2022, 101(51): e32425. doi: 10.1097/MD.0000000000032425.
27.	Chung YJ, Koo MG, Lee SH. Epicanthal restoration surgery with scar excision in severe epicanthal scar. Aesthetic Plast Surg, 2018, 42(3): 839-846.
28.	隋長清, 余海洋, 李丹, 等. A字法內眥贅皮過度矯正修復術的效果. 中華醫學美學美容雜志, 2024, 30(2): 140-143.
29.	Ha JH, Park YO, Jin US. Revisional medial epicanthoplasty using reverse Z-plasty technique. Aesthet Surg J, 2022, 42(1): 10-15.
30.	Zhang HH, Xue D, Qian J, et al. The application of reverse Z-plasty design in medial canthal skin redundancy reconstruction surgery. J Craniofac Surg, 2024, 35(4): 1253-1257.
31.	Huang ZC, Yan D, Huang LF, et al. Clinical application of a bird-beak-type Z-shaped asymmetrical flap in the reconstruction of the inner canthus. Front Surg, 2022, 9: 786370. doi: 10.3389/fsurg.2022.786370.
32.	Wang B, Zhang S, Chen Y, et al. A comparative retrospective analysis: myocutaneous flap versus skin flap in V-Y medial epicanthal fold reconstruction. Front Surg, 2024, 11: 1335796. doi: 10.3389/fsurg.2024.1335796.
33.	郝國梁, 袁繼龍, 韓明倩, 等. 內眥贅皮的美學認知及內眥重建術的應用進展. 中國美容整形外科雜志, 2023, 34(1): 19-22.

1. 劉暢, 王太玲. 內眥贅皮診療研究進展. 中華整形外科雜志, 2021, 37(12): 1397-1403.
2. Saonanon P. The new focus on epicanthoplasty for Asian eyelids. Curr Opin Ophthalmol, 2016, 27(5): 457-464.
3. 王詩萌. 內眥纖維帶在亞洲人中、重度內眥贅皮成因及臨床應用研究. 長春: 吉林大學, 2023.
4. Fakhro A, Yim HW, Kim YK, et al. The evolution of looks and expectations of Asian eyelid and eye appearance. Semin Plast Surg, 2015, 29(3): 135-144.
5. Tong J, Wang R, Sun J, et al. Modified Z-epicanthoplasty based on the movement and tension of medial canthal area in Asian females. J Craniofac Surg, 2021, 32(6): 2198-2201.
6. Lyu D, Jin Y, Chang L, et al. The Modified Z-epicanthoplasty-a stepwise and individualized design. Ann Plast Surg, 2017, 78(1): 7-11.
7. Zan T, Jin R, Li H, et al. A novel U-flap epicanthoplasty for Asian patients. Aesthetic Plast Surg, 2016, 40(4): 458-465.
8. Zhang S, Xue H. Upper arch flap combined with extended incision of lower eyelid: A modified epicanthoplasty in correcting epicanthus. Aesthetic Plast Surg, 2018, 42(4): 1033-1038.
9. Xie A, Cao Y, Yu D. Combined transverse incision and pouch incision for the correction of medial epicanthus. J Craniofac Surg, 2019, 30(5): 1499-1502.
10. Oh J, Lee K. Medial lower lid epiblepharon repair solely by skin-redraping medial epicanthoplasty. Br J Ophthalmol, 2014, 98(10): 1437-1441.
11. Liu HP, Zhao YY, Li B, et al. The orbicularis oculi muscle resection technique for medial epicanthoplasty: A retrospective review of surgical outcomes in 47 Chinese patients. J Plast Reconstr Aesthet Surg, 2017, 70(1): 96-103.
12. Sun W, Yin N, Song T, et al. A practical technique combining orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty. J Plast Reconstr Aesthet Surg, 2019, 72(12): 2009-2016.
13. Kiranantawat K, Suhk JH, Nguyen AH. The Asian eyelid: Relevant anatomy. Semin Plast Surg, 2015, 29(3): 158-164.
14. McCurdy JA. Beautiful eyes: characteristics and application to aesthetic surgery. Facial Plast Surg, 2006, 22(3): 204-214.
15. Li Z, Zhang S, Yu J, et al. Double eyelid shape preference: A large sample survey. Aesthetic Plast Surg, 2022, 46(5): 2287-2294.
16. Hwang HS, Spiegel JH. The effect of “single” vs “double” eyelids on the perceived attractiveness of Chinese women. Aesthet Surg J, 2014, 34(3): 374-382.
17. 王成源, 呂唯, 莊巖, 等. 中國人對內眥贅皮的美學認知調查. 中國美容整形外科雜志, 2015, 26(7): 407-410.
18. Shin YH, Hwang PJ, Hwang K. V-Y and rotation flap for reconstruction of the epicanthal fold. J Craniofac Surg, 2012, 23(4): e278-280.
19. Kim J, Kim J, Kim J, et al. Autologous tissue graft in revision medial epicanthoplasty using subciliary fat and orbicularis oculi muscle. J Craniofac Surg, 2017, 28(8): 1972-1975.
20. Lee TY, Shin YH, Choi DI. Reconstruction of medial epicanthal fold using V-Y advancement and turnover flap. J Plast Reconstr Aesthet Surg, 2020, 73(2): 363-368.
21. 石海山, 劉海蘭, 劉輔容, 等. 一種修復內眥贅皮矯正術后形態不良的新方法. 中華整形外科雜志, 2023, 39(10): 1094-1099.
22. 潘貳, 王布霖, 于建剛, 等. 眼輪匝肌肌皮瓣V-Y成形術修復內眥過大畸形. 中華整形外科雜志, 2022, 38(11): 1283-1288.
23. Xu L, Wang H, Ma T, et al. Reconstruction of medial epicanthal fold using dual-plane V-Y advancement flap. Aesthetic Plast Surg, 2025, 49(10): 2727-2734.
24. Chung YJ, Kong JS, Kim YW, et al. Restoration of the medial epicanthal fold: reverse skin redraping method in patients unsatisfied with epicanthoplasty. Ann Plast Surg, 2013, 71(5): 456-460.
25. Chung YJ, Han KE, Park BY. Restoration of complicated epicanthus: Modified reverse skin redraping with mini-epicanthoplasty for rescue in unsatisfied epicanthoplasty patients. Ann Plast Surg, 2017, 78(6): 613-617.
26. Chung YJ, Park BY. Reoperation of epicanthal reconstruction using a modified reverse skin-redraping method. Medicine (Baltimore), 2022, 101(51): e32425. doi: 10.1097/MD.0000000000032425.
27. Chung YJ, Koo MG, Lee SH. Epicanthal restoration surgery with scar excision in severe epicanthal scar. Aesthetic Plast Surg, 2018, 42(3): 839-846.
28. 隋長清, 余海洋, 李丹, 等. A字法內眥贅皮過度矯正修復術的效果. 中華醫學美學美容雜志, 2024, 30(2): 140-143.
29. Ha JH, Park YO, Jin US. Revisional medial epicanthoplasty using reverse Z-plasty technique. Aesthet Surg J, 2022, 42(1): 10-15.
30. Zhang HH, Xue D, Qian J, et al. The application of reverse Z-plasty design in medial canthal skin redundancy reconstruction surgery. J Craniofac Surg, 2024, 35(4): 1253-1257.
31. Huang ZC, Yan D, Huang LF, et al. Clinical application of a bird-beak-type Z-shaped asymmetrical flap in the reconstruction of the inner canthus. Front Surg, 2022, 9: 786370. doi: 10.3389/fsurg.2022.786370.
32. Wang B, Zhang S, Chen Y, et al. A comparative retrospective analysis: myocutaneous flap versus skin flap in V-Y medial epicanthal fold reconstruction. Front Surg, 2024, 11: 1335796. doi: 10.3389/fsurg.2024.1335796.
33. 郝國梁, 袁繼龍, 韓明倩, 等. 內眥贅皮的美學認知及內眥重建術的應用進展. 中國美容整形外科雜志, 2023, 34(1): 19-22.

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