Dual-Surface Epicanthoplasty for Conservative-to-Moderate Medial Canthal Opening in East Asian Eyelids.

Abstract

Background: Epicanthoplasty aims to improve medial canthal exposure while minimizing visible scarring and postoperative tension. This study describes Dual-Surface Epicanthoplasty, a dual-surface technique for conservative-to-moderate medial canthal opening in East Asian eyelids, guided by a three-dimensional fold-unit concept that coordinates external cutaneous redraping with internal fold turning-point reconstruction.

Methods: This retrospective study included 80 patients (140 eyes) with clinically evident epicanthal folds and limited medial canthal exposure treated between February 2023 and April 2025. Outcomes were analyzed at the patient level using averaged bilateral values when applicable. Patients were categorized by surgical laterality and procedure type, and exploratory subgroup analyses compared isolated epicanthoplasty with epicanthoplasty combined with upper blepharoplasty. Morphologic outcomes included visible lacrimal lake width (VLLW), normalized VLLW, and exploratory intraoperative medial canthal fold depth (MCFD). Secondary outcomes included scar visibility, patient satisfaction, and complications.

Results: Mean follow-up was 11.9 ± 2.8 months. VLLW increased from 1.47 ± 0.71 mm to 3.38 ± 0.34 mm, and normalized VLLW increased from 0.128 ± 0.060 to 0.299 ± 0.027 (both p < 0.001). MCFD decreased from 3.43 ± 0.26 mm before deep release to 2.68 ± 0.25 mm after D-A key suturing (p < 0.001). Median scar visibility score was 0 (IQR, 0-0), and median satisfaction score was 5 (IQR, 4-5). Hypertrophic scarring occurred unilaterally in 3 patients (3.8%), all within the asymmetry-revision subgroup. Interocular medial canthal asymmetry requiring unilateral revision occurred in 4 patients (5.0%).

Conclusions: Dual-Surface Epicanthoplasty may be feasible for selected East Asian patients seeking conservative-to-moderate medial canthal opening and was associated with increased lacrimal lake exposure, reduced exploratory intraoperative fold depth, low scar visibility, and high satisfaction. Controlled studies with reliability testing and longer follow-up are needed.

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