Anchor epicanthoplasty combined with out-fold type double eyelidplasty forAsians: Do we have to make an additional scar to correct the Asian epicanthal fold?

The epicanthal fold along with a lack of a superior palpebral fold, excessi ve fat, and laxity of pretarsal skin represent the ethnic characteristics a nd a traditional sense of beauty in the Asian upper eyelid. But, too promin ent an epicanthal fold may ruin an otherwise beautiful eye; furthermore, it becomes a restriction that makes the out-fold type double eyelidplasty, on e of the two main types of double eyelidplasty, impossible. If a double eye lid as an out-fold type is desired, a concomitant epicanthoplasty should be performed with the possibility of hypertrophic scarring of the medial cant hal area in Asians. To address the Asian epicanthal fold without danger of hypertrophic scarring, the authors developed an anchor epicanthoplasty tech nique that leaves no additional scar when combined with a double eyelidplas ty. This technique is based on the concept of trimming of muscle and soft t issue under the Asian epicanthal fold and downward medial advancement and a nchoring of the medial canthal skin to the deep tissue. The technique consi sts of five procedures based on the assumed causes of the Asian epicanthal fold: (1) augmentation rhinoplasty, (2) downward medial advancement of the medial upper lid skin, (3) removal of the superficial insertion of the medi al canthal ligament and selective removal of the orbicularis oculi muscle, (4) sub cutaneous contouring of the thick nasal skin, and (5) anchoring of the medial end of the incision to the deep tissue. During the past 12 years (1988 to 1999), 67 anchor epicanthoplasty procedures have been performed. Twenty-eight cases were followed up for more than 3 months, and all of the patients were satisfied with the results. There were only a few minor compl ications, which could be corrected with minimal revision. As an ancillary p rocedure to a double eyelidplasty, this anchor epicanthoplasty can reduce t he Asian epicanthal fold and make a double fold as an out-fold type without an additional scar. In terms of hypertrophic scarring and compatibility wi th out-fold type double eyelidplasty, this anchor epicanthoplasty is the be st method for correcting Asian epicanthal fold compared with other preexist ing procedures. Other advantages of this technique are a wide range of appl ications and no compromise of medial canthal skin to interfere with other e picanthoplasty techniques. Some disadvantages of this technique are technic al difficulty and the possibility of active bleeding.