The five-flap technique for blepharophimosis

The correction of epicanthus associated with blepharophimosis is a difficult surgical problem. Most commonly used techniques, such as the Mustardé technique, require meticulous measurements, and their theoretical geometric basis and flap designs are often confusing. We present the five-flap technique utilizing logical flap design, which is a combination of a Y-to-V flap with double opposing Z-plasties on the apex, that is well suited to this difficult problem. It is important to remove excess muscle and deep tissues underlying the flaps in the medial canthal region, which are present in blepharophimosis cases and contribute to the deformity in these patients. Medial canthal tendon resection and tucks or transnasal wiring are then performed. The technique has been utilized in 14 patients with a minimum of one year of follow-up over the past six years with good results.