Medial epicanthoplasty without a vertical scar.

BACKGROUND: The epicanthal fold (Mongolian fold) in Asians reduces the aesthetic results of eyelid surgery, and thus, medial epicanthoplasty is commonly performed in combination with a double fold operation or blepharoptosis correction. Epicanthoplasty is one of the most popular cosmetic operations conducted in Asia, but scarring is a common problem. METHODS: From December of 2006 to July of 2011, we treated 60 cases using our epicanthoplasty method, which was designed to reduce scarring. A double fold operation and blepharoptosis correction was performed along with epicanthoplasty in 54 cases and an epicanthoplasty without a double fold operation in the remaining 6 cases. Follow-up periods ranged from 6 months to 4 years and 10 months. Previously, we used an elliptical excision epicanthoplasty method, which was simple and practical. However, the elliptical excision method leaves a vertical scar on the nasal side of the upper and lower eyelids. To avoid this scar, we placed an additional incision parallel with the ciliary margin of the lower and/or upper eyelids. The results of epicanthoplasty were evaluated by asking the patients and the surgeon involved to allocate visual analog scale scores. RESULTS: With the exception of 1 case of hypertrophic scarring and 4 cases of undercorrection, patients were satisfied with their results. Mean patient and surgeon visual analog scale scores were 4.6 and 4.2, respectively. The advantages of the described procedure are its simplicity and the minimal scarring caused in the epicanthal area. CONCLUSIONS: This method could become an effective means of removing the Asian epicanthal fold and minimizing vertical scars.

Analysis of the patterns of lateral canthal rhytids and reference for botulinum toxin treatment in orientals.

BACKGROUND: One of the earliest signs of aging is the appearance of wrinkles in the skin at the outer corners of the eyes (lateral canthal rhytids). The purpose of this study was to divide the lateral canthal rhytids into classified groups and describe their clinical characteristics and suitable treatments. METHODS: A total of 525 patients were included in the study. These patients were groups according to age and sex. Digital photographs of the subject's lateral canthal rhytids (lateral view) were taken and classified as to type (upper, lower, and bidirectional) and degree of direction. RESULTS: A total of 425 patients (81 %) exhibited the bidirectional type of lateral canthal rhytids. The lower directional type was noted on 75 patients (14.3 %), while only 25 patients (4.7 %) exhibited the upper directional type. In the 30s age group, only 50 % exhibited the bidirectional type. However, this rate increased to a 100 % in the 60 year-old and above group. There seems to be no relationship between the type of lateral canthal rhytids and sex. The degrees of the angle of wrinkles were statistically significant only in the 30s and 40s age groups. CONCLUSIONS: We classified lateral canthal rhytids into three groups. This classification helps to decrease the complications of botulinum toxin by associating different treatments with the type of lateral canthal rhytids. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.