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

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .