ObjectiveTo investigate the effectiveness of combined three operations (rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty) for one stage defect repair after resection of xanthelasma palpebrarum with epicanthus. MethodsBetween December 2013 and December 2015, 12 female patients with large xanthelasma palpebrarum and epicanthus underwent rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty for one stage defect repair. The age ranged from 36 to 59 years (mean, 43 years). The course of disease was 3 to 16 years, with an average of 11 years. The initial resection was performed in 6 cases, second resection of residual xanthelasma palpebrarum in 4 cases, and 2 cases had recurrence after resection. The maximum diameter of xanthelasma palpebrarum was 0.5-1.3 cm (mean, 1.0 cm). According to CHE Junmin et al criterion, epicanthus was rated as mild in 7 cases, moderate in 3 cases, and severe in 2 cases. The blood lipid level was in normal range. ResultsPrimary healing of incision was obtained, and the flaps survived in all patients; no complication occurred. Scar hyperplasia was found in 4 cases at 1 month after operation, and the comprehensive treatment of scar was performed. All patients were followed up for 3 months to 2 years, with an average of 1.5 years. Double eyelid effects were good, and no xanthelasma palpebrarum recurred. ConclusionA combination of rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty is an effective operative procedure to repair defect after resection of xanthelasma palpebrarum with epicanthus; and better curve of double eyelid, better shape of endocanthion, and less tension of flap can be got.
ObjectiveTo introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness.MethodsThe clinical data of 119 patients underwent epicanthoplasty with modified transsection and longitudinal suture and with a follow-up time over 6 months between February 2014 and December 2016 were retrospectively analyzed. There were 8 males and 111 females with an average age of 22.7 years (range, 18-38 years). The epicanthus was as eyebrow type in 12 cases, as eyelid type in 57 cases, as tarsalis type in 39 cases, and as backward type in 11 cases. The narrow degree of epicanthus included mild (the lacrimal caruncle covered size was less than 1/3) in 42 cases, moderate (the lacrimal caruncle covered size was between 1/3 and 2/3) in 58 cases, and severe (the lacrimal caruncle covered size was over 2/3) in 19 cases. One hundred and thirteen patients were treated by blepharoplasty at the same time. The new canthus was located on the basis of the inner canthus physiological aesthetics. Through a short transverse incision, dislocated orbicularis oculi muscle near medial canthal ligament and the fiber between the medial canthal ligament and skin were completely released; then the medial canthal ligament was shortened precisely and the incision was tension-free sutured followed the Langer’s line near eyes.ResultsAll the incisions healed by first intention. All patients were followed up 6 months to 2 years (mean, 8.6 months). The bilateral hypertrophic scar on both bilateral medial canthal incisions happened in 3 patients at 3-6 months after operation; and the scarring gradually subsided at 10 months after the diprospan injections and the siliconegel and carbon dioxide laser treatment. Good effectiveness were obtained in the other patients, whose inner intercanthal distance significantly narrowed, both of the horizontal lid fissure length increased, the lacrimal caruncle fully exposed, and no obvious scar could be seen.ConclusionThe modified transsection and longitudinal suture in epicanthoplasty has the advantages of simple design, easy operation, minimally invasive, inconspicuous scar, and obvious, stable, and lasting postoperative effectiveness.
ObjectiveTo evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision.MethodsA clinical data of 34 patients with mild and moderate epicanthus (trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed. And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional " Z” plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups (P>0.05). The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre- and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics.ResultsAll incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision; and there were scars at inner canthus of control group, with obvious hyperplasia in 6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%, 3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups (t=0.005, P=0.996; t=0.287, P=0.871). The effectiveness was excellent in 20 cases, good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%; meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%. There was no significant difference between 2 groups (χ2=0.796, P=0.372).ConclusionThe modified epicanthoplasty by using upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.