Cosmetic and structural outcomes of two different techniques of medial epicanthoplasty according to epicanthal fold classification and severity: A cohort study

This study aimed to compare the cosmetic and structural outcomes of two techniques for medial epicanthoplasty of the epicanthal fold, which varied in classification and severity.Medical records and photographs of 106 patients (212 eyes) who underwent medial epicanthoplasty by the modified Z-plasty or modified redraping techniques were reviewed retrospectively. They underwent surgery from January 2009 to June 2017 and completed a follow-up of 6 months. The cosmetic outcome was evaluated in terms of satisfactory, symmetry, smoothness, and scarring by a four-point scoring method, and the structural outcome was assessed by the ratio of intercanthal distance (ICD) and interpupillary distance (IPD). The two surgical techniques in the same epicanthal classification and severity were compared and analyzed.The modified Z-plasty and modified redraping techniques had similar outcomes for satisfaction level in all types of epicanthal folds. The modified Z-plasty scored significantly higher for scarring in mild, moderate, and severe epicanthus palpebralis (p = 0.034, 0.028, and 0.013, respectively). The modified redraping technique scored significantly higher for smoothness in mild epicanthus tarsalis (p = 0.025). In epicanthus palpebralis, the postoperative ICD/IPD ratio in the redraping technique was significantly low (p = 0.001 and 0.000, respectively), whereas the preoperative ratio showed no significant difference. In epicanthus tarsalis, the postoperative ICD/IPD ratio showed no significant difference, whereas the preoperative ratio showed significantly difference (p = 0.011 and 0.002, respectively).The modified Z-plasty provided less scarring in epicanthus palpebralis. The modified redraping technique provided more smoothness in mild epicanthus tarsalis, and it was more efficient in shortening the ICD.