Revisional Medial Epicanthoplasty Using Reverse Z-plasty Technique

Background Medial epicanthoplasty is a common method for correcting epicanthal folds in Asians but sometimes cause unsatisfactory results. Although several procedural variations have been devised, revision techniques have earned little attention. Revision technique we have developed uses reverse Z-plasty to restore an overcorrected epicanthal fold. Objectives The aim of this study was to investigate the effectiveness of our reverse Z-plasty technique in restoring natural medial canthal region harmonizing with Asian face. Methods From January 2010 to December 2016, reverse Z-plasty was performed in patients seeking revisions after previous medial epicanthoplasties. Patients were surveyed to assess their satisfaction with surgical outcomes. Interepicanthal distance (ICD) lengthening ratios and symmetry of palpebral widths were evaluated digitally (ImageJ software) in patients who received revisional epicanthoplasty only. Results Our reverse Z-plasty technique for revisional epicanthoplasty was performed in 548 Asian patients (male, 83, female, 460). Most patients were pleased with the final outcomes. Only 6% submitted to later revisions of scars, which were otherwise scarcely visible after 3 months. Among 60 patients who only underwent revisional epicanthoplasty, ICD lengthening ratios ranged from 2.9–31.1% (average, 8.6%), and palpebral width symmetries improved. Conclusions This particular technique helps restore the three-dimensional appearance of medial canthal angle through horizontal skin and soft tissue (including muscle and ligament) restructuring, thus compensating for tissue deficiency. It is simple in design, easy to perform, and satisfactory results were achieved, conferring natural aesthetics to the medial canthal region.

Medial Epicanthoplasty: What Works and What Does Not

Blepharoplasty is the most frequently performed cosmetic surgical procedure in Asia. The epicanthal fold, which is common in Asians, is characterized by a curved skin fold that partially hides the caruncle and lacrimal lake. The epicanthal fold may cause weakening of the esthetic appearance after blepharoplasty. It makes the palpebral fissure height narrower and the length shorter horizontally. Blepharoplasty with epicanthoplasty can enhance the esthetic appearance, but no gold standard surgical technique has been established for epicanthoplasty. Surgeons can choose the surgical technique according to their preference and the patient's characteristics. A carefully designed and fine surgical technique, especially with the use of loupes and tension-free skin closure with the thinnest needle, is required to avoid scarring.

Sirenomelia with Potter's facies - a case report

A specimen of Sirenomelia from the department of Anatomy, Mahatma Gandhi Medical College and Research Institute, Pondicherry is presented here. This specimen was examined in detail and X-Ray was taken. On examination, the specimen showed i) Fused lower limb like a stump, ii) Undifferentiated genital organs, iii) Widely spaced nipples, iv) Receded chin and webbed neck, v) Low set large ears, vi) Epicanthal fold, vii) Flattened nose, viii) Absence of anal orifice. Fused lower limbs with associated undifferentiated genital organs and absence of anal orifice was found interesting to study and reported here as a case. The presence of Fused lower limb like a stump is suggestive of Sirenomelia and presence of i) Widely spaced nipples ii) Receded chin and webbed neck, iii) Low set large ears, v) Epicanthal fold, vi) Flattened nose is suggestive of Potter's Facies. It is presented here due to rarity of occurrence of such anomaly.