Medial Epicanthoplasty with the Skin-Redraping Technique: Technical Refinements for Predictable Outcomes

The epicanthus is a common feature of Asian eyes. A prominent medial epicanthal fold gives the impression of blunted affect. Medial epicanthoplasty for its removal is commonly requested by Asian patients. This may be performed as an isolated procedure or, more commonly, in combination with upper blepharoplasty. Many conventional medial epicanthoplasty techniques are based on skin flap transposition and excisions, usually variations of the V-Y, W, or Z-plasties. Although these have been variably successful at correcting the epicanthal fold, scarring in the medial canthal and lower eyelid regions is common. This is particularly problematic in Asian patients, who have greater tendencies for hypertrophic scarring and scar hypopigmentation or hyperpigmentation. Recently, the skin redraping method, designed with incisions limited within the margins of the medial canthus and precise and targeted disruption of the underlying fibromuscular tissues, has emerged as the preferred surgical technique for many surgeons in Asia because of its effectiveness and superior aesthetic outcomes. This technique delivers the most inconspicuous incisions and is advantageous because it is effective in eliminating epicanthal folds of various severities. Precise execution of this technique is difficult, given the complex 3-dimensional anatomy of the epicanthus. The authors present a detailed explanation of surgical concepts of the skin redraping epicanthoplasty and provide a step-by-step guide to performing this procedure in a safe and effective manner.