Rotation ligamentoplasty for the correction of epicanthus inversus

Epicanthus, with its various types, is characterized by an arching fold at the sides of the nose, with a concavity directed laterally. Epicanthus inversus, one of these types, which occurs with varying frequency in all races, is most common among Asians. In epicanthus inversus, the medial canthus is displaced laterally and the medial canthal depression is shallow or absent. The lower puncta is displaced laterally as well. Correction of epicanthus is easy with Z-plasties or with the four-flap technique of Mustardé. However, inverted epicanthus cannot be repaired using these techniques, as proved by others. The authors suggest rotating the medial canthal ligament during transnasal wiring to support the eversion of the laterally displaced medial lower lid, lower puncta, and surrounding skin. Eight patients with epicanthus inversus were operated and followed for at least 15 months. The results were satisfactory according to a graded scale.