Epicanthal Fold Reconstruction Using V-Y Advancement and Triangular Flap

Epicanthoplasty is frequently performed in Asian populations, but overcorrection-resulting in undesirable aesthetic and functional outcomes-remains a persistent challenge.

This study investigates the efficacy of a novel technique combining V-Y advancement with a triangular flap for reconstructing iatrogenic overcorrection of epicanthal folds, with emphasis on anatomic precision and individualized aesthetic restoration.

19 patients with overcorrection secondary to prior blepharoplasty underwent bilateral reconstruction using the proposed technique. Meticulous anatomic markings guided the V-Y advancement and triangular transposition flap to correct tissue deficiencies. Preoperative and postoperative (1-week and 1-month) medial canthal angles were quantitatively analyzed using standardized imaging and software. We also administered standardized surveys at 1-month (n = 19), 3-month (n = 15), and 6-month (n = 12) intervals following epicanthal fold reconstruction.

The medial canthal angle significantly increased from 55.94 ± 5.12° preoperatively to 58.63 ± 2.80° at 1 month postoperatively ( P = 0.026), confirming successful anatomic reconstruction. Longitudinal analysis revealed sustained enhancement in satisfaction rate at 6 months (58.3% very satisfied, 41.7% satisfied). The technique consistently improved lacrimal caruncle coverage, refined the medial canthal contour, and reduced medial double-eyelid width, eliminating the need for secondary revisions in most cases.

The integrated V-Y advancement and triangular flap technique offers a reliable and adaptable solution for addressing epicanthal fold overcorrection, effectively balancing functional and aesthetic demands. Long-term studies with objective morphometric analyses are essential to further establish its clinical utility.