Z-Epicanthoplasty Combined with Double Eyelidplasty: Its Indication, Results & Pitfalls

The formation of pretarsal fold without modification of the medial canthal folds may produce eyes with rounder and narrower palpebral fissures. In the last 6 years, the authors performed double eyelidplasty in 16 patients with Oriental eyelids and type III medial epicanthal fold. In 9 patients, simple double eyelidplasty was performed and in 7 patients double eyelidplasty combined with Z-epicanthoplasty were performed. The aesthetic and functional outcomes, and overall patient satisfaction were followed up in 15 patients up to 5 years. In group of double eyelidplasty only, results were equivalent to Good selectively in only 4 patients who had relatively long preoperative palpebral fissure. The epifolds were sustaining in all patients. Remaining patients showed Fair or Poor results. In group of double eyelidplasty combined with Z-epicanthoplasty, all patients showed Good or Excellent results except one who had defective scar maturation. To achieve apparent aesthetic enhancement and beautiful looking eyes with lengthy palpebral fissure in patients with Type III or IV medial canthal epifold, epicanthoplasty should be combined with double eyelidplasty. It achieves apparent aesthetic enhancement by eliminating the medial epicanthal fold and opening the lacrimal lake widely leaving minimal scar and natural supratarsal skin fold line in a single stage operation.

Simultaneous Reconstruction of the Alar and its Neighboring Area using Bielliptical Flap

It is difficult to repair defects of the alar nasi because of its complex configuration and the structural support which enables to ensure an adequate patency of nasal airway. Furthermore, if the defect is extended to neighboring areas such as the nostril, vestibular floor, and upper lip, proper selection and execution of repair technique is of utmost importance. We considered the alar and perialar area to be two different aesthetic units and so reconstruction of the defect with two regional flaps would yield better result. We designed vertical bielliptical flap as two regional flaps (nasolabial and nasojugal flap). A vertical bielliptical flap commonly based on the perforators from the facial artery on alar groove was developed. With this flap, the defect of the alar and its neighboring area was simultaneously reconstructed. Fuctional and aesthetic result was good.

Simultaneous Reconstruction of the Alar and its Neighboring Area using Bielliptical Flap

It is difficult to repair defects of the alar nasi because of its complex configuration and the structural support which enables to ensure an adequate patency of nasal airway. Furthermore, if the defect is extended to neighboring areas such as the nostril, vestibular floor, and upper lip, proper selection and execution of repair technique is of utmost importance. We considered the alar and perialar area to be two different aesthetic units and so reconstruction of the defect with two regional flaps would yield better result. We designed vertical bielliptical flap as two regional flaps (nasolabial and nasojugal flap). A vertical bielliptical flap commonly based on the perforators from the facial artery on alar groove was developed. With this flap, the defect of the alar and its neighboring area was simultaneously reconstructed. Fuctional and aesthetic result was good.