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imagePurpose: To describe a medial epicanthoplasty technique using a stepwise, customized design and to review the outcome in Asian patients after the treatment of medial epicanthal fold.
Design: Retrospective, noncomparative and interventional case series with the introduction of a new surgical technique.
Participants: Forty-eight consecutive Asian patients with primary medial epicanthal fold.
Methods: Patient charts were reviewed from patients (mean age, 24.6 ± 3.8 years; range, 19–40 years) with a stepwise z-epicanthoplasty. The intercanthal distance (ICD), interpupillary distance (IPD), and scar visibility were evaluated at regular intervals (preoperative, immediate postoperative, 3 months, 6 months, and 1 year after the operation). The ratio of the ICD to IPD (ICD ratio) was calculated, and the visibility of the surgical scar assessed.
Main Outcome Measures: Postoperative improvement in ICD ratio and scar quality.
Results: The preoperative median ICD ratio was 0.60 (range, 0.57–0.66) and decreased to 0.57 (range, 0.52–0.60) postoperatively. The median ICD ratio reduction was 5.6% (range, 2.6–14.1%; P < 0.001, Wilcoxon signed-rank test). Forty patients (83.3%) had no visible scarring or scarring only visible under close inspection. Eight patients (16.7%) experienced a more apparent scar, but none of them developed a severe scar requiring revision.
Conclusions: The modified z-epicanthoplasty using a stepwise design is a customized and effective technique for the treatment of the epicanthal fold. This method has a short learning curve, is widely applicable to various types of epicanthal fold, and has a high satisfaction rate with a stable long-term result.

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