Comparison of Modified Asymmetric Inverse Z-plasty and Z-plasty in the Correction of Epicanthal Folds

Epicanthoplasty is the most common cosmetic eye surgery. However, traditional surgical strategies usually cause visible scars in the medial canthus. This study innovatively aimed to propose a modified asymmetric inverse Z-plasty derived from the traditional Z-plasty technique to minimize postoperative scars and consequently enhance patient satisfaction.

This retrospective study included 172 patients with epicanthal folds who underwent an epicanthoplasty. Group A patients (n = 94) underwent modified asymmetric inverse Z-plasty, whereas Group B patients (n = 78) underwent Z-plasty. Postoperative outcomes, including scarring (assessed using the Vancouver scar scale [VSS]), scar hiding degree, patient satisfaction, and recurrence rates, were evaluated at 6 months.

Postoperative evaluations revealed that both groups achieved normal wound healing without infections or complications after 7 days. VSS assessments indicated superior scar outcomes in Group A patients with moderate-to-severe epicanthal folds compared with those in Group B participants. Scar hiding degree analysis demonstrated a significantly higher percentage of postoperative pure hidden scars in Group A (P = 0.0042), particularly in moderate (P < 0.0001) and severe epicanthal folds (P = 0.002). Patient satisfaction was significantly higher in Group A (79.8%, very satisfied) than in Group B (47.4%, P < 0.0001). However, no significant difference in recurrence rates was observed between the two groups.

Patients treated with modified asymmetric inverse Z-plasty exhibited superior scar hiding degree and overall satisfaction compared to those who underwent Z-plasty. Hence, modified asymmetric inverse Z-plasty is an effective treatment for patients with epicanthal folds, particularly in moderate-to-severe cases.

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