Epikanthal folds are a common eye feature among Chinese and East Asians. These folds at the inner corners of the eyes were originally thought to shield against wind and sand. However, in modern urban environments, they serve no practical purpose and can make eyes appear narrow and lackluster. Plastic surgeons note that there are eight distinct methods for epicanthoplasty, each with its own advantages and disadvantages.>1. Y-V Advancement Eyelid Surgery Method
Advantages: Relatively simple with effective tissue release.
Disadvantages: Requires removal of some skin.
2. Horizontal Incision Eyelid Surgery Method
Advantages: Simple procedure widely adopted by many surgeons.
Disadvantages: Involves excising already insufficient skin. The neat V-shaped incision is prone to contraction, recurrence, or even worsening of the condition.
III. Z-Plasty Eyelid Surgery Method
Advantages: Simple procedure.
Disadvantages: Insufficient release, suitable only for mild epicanthal folds.
IV. V- or L-Shaped Skin Excision Eyelid Surgery Method
Advantages: Simple, often used by beginners.
Disadvantages: Involves skin removal, prone to recurrence or worsening.
V. One-Step Advancement Technique: Equivalent to V-Y advancement and L-shaped skin excision, invented by Korean surgeons and widely used in Korea.
Advantages: Relatively simple with effective dissection.
Disadvantages: Requires partial skin excision, resulting in a slightly downward-slanted canthus shape.
VI. W-Shaped Canthoplasty: Popular among Japanese surgeons.
Advantages: Simple.
Disadvantages: Requires removal of a small amount of skin.
VII. Modified Mustarde Eyelid Surgery Method
After evaluating multiple techniques, experts concluded the Mustarde method achieves thorough release. Modifications were made to overcome drawbacks like excessive scarring.
Advantages: Thorough release, smooth results, no skin excision.
Disadvantages: Requires intricate technique and high skill level.
VIII. MUSTARDE Eyelid Surgery Method: Comprises one V-Y advancement and two Z-plasties.
Advantages: Achieves the most thorough dissection.
Disadvantages: Complex procedure demanding advanced technical proficiency. The classic Mustarde design is mechanistic and prone to significant scarring.