Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Skin redraping for correction of lower eyelid epiblepharon combined with medial epicanthal fold: a retrospective analysis of 286 Asian children

Abstract

Objective

This study was performed to evaluate the clinical effect of skin redraping on lower eyelid epiblepharon accompanied by a medial epicanthal fold.

Methods

This retrospective case series involved 572 eyes of 286 patients who underwent skin redraping surgery to treat lower eyelid epiblepharon accompanied by a medial epicanthal fold from January 2015 to May 2019. The postoperative surgical results were classified as “good”, “fair” and “poor”. The incision scars were assessed using the Vancouver scar scale. The patients’ subjective satisfaction and incidence of complications were also documented.

Results

The mean patient age at the time of surgery was 6.9 ± 3.6 years (3–12 years), and the mean follow-up time was 32.6 ± 13.5 months (6–58 months). The clinical symptoms and severity of keratopathy were improved postoperatively. “Good” surgical outcomes were obtained in all patients, the mean Vancouver scar scale score was 1.1 ± 0.3, and hypertrophic scar formation did not occur. A total of 272 patients and their guardians were “very satisfied” with the cosmetic outcomes.

Conclusion

Skin redraping was effective and endurable in the treatment of lower eyelid epiblepharon accompanied by a medial epicanthal fold. The postoperative scars were slight and nearly invisible, and no cases of recurrence were observed in this study.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Surgery technique of skin redraping method.
Fig. 2: Preoperative and postoperative photograph of a 7-year-old child.
Fig. 3: Preoperative and postoperative photograph of a 6-year-old child.

References

  1. Noda S, Hayasaka S, Setogawa T. Epiblepharon with inverted eyelashes in Japanese children. I. Incidence and symptoms. Br J Ophthalmol. 1989;73:126–7.

    Article  CAS  Google Scholar 

  2. Oh J, Lee K. Medial lower lid epiblepharon repair solely by skin-redraping medial epicanthoplasty. Br J Ophthalmol. 2014;98:1437–41.

    Article  Google Scholar 

  3. Seo JW, Kang S, Ahn C, Esmaeli B, Sa HS. Non-incisional eyelid everting suture technique for treating lower lid epiblepharon. Br J Ophthalmol. 2018;102:1504–9.

    Article  Google Scholar 

  4. Kim MS, Sa HS, Lee JY. Surgical correction of epiblepharon using an epicanthal weakening procedure with lash rotating sutures. Br J Ophthalmol. 2014;98:120–3.

    Article  Google Scholar 

  5. Lin CC, Lai CC. Modified Hotz procedure with CO2 laser ablation of the orbicularis oculi muscle for epiblepharon. Can J Ophthalmol. 2019;55:63–7.

  6. Khwarg SI, Choung HK. Epiblepharon of the lower eyelid: technique of surgical repair and quantification of excision according to the skin fold height. Ophthalmic Surg Lasers. 2002;33:280–7.

    Article  Google Scholar 

  7. Hayasaka S, Noda S, Setogawa T. Epiblepharon with inverted eyelashes in Japanese children. II. Surgical repairs. Br J Ophthalmol. 1989;73:128–30.

    Article  CAS  Google Scholar 

  8. Asamura S, Nakao H, Kakizaki H, Isogai N. Is it truly necessary to add epicanthoplasty for correction of the epiblepharon? J Craniofac Surg. 2013;24:1137–40.

    Article  Google Scholar 

  9. Shin DH, Woo KI, Kim YD. Relationship between lower eyelid epiblepharon and epicanthus in Korean children. PLoS ONE. 2017;12:e0187690.

    Article  Google Scholar 

  10. Ni J, Shao C, Wang K, Chen X, Zhou S, Lin H. Modified Hotz procedure combined with modified Z-Epicanthoplasty versus modified Hotz procedure alone for epiblepharon repair. Ophthalmic Plast Reconstr Surg. 2017;33:120–3.

    Article  Google Scholar 

  11. Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers. Burns. 2015;41:1442–8.

    Article  Google Scholar 

  12. Lai CS, Lai CH, Wu YC, Chang KP, Lee SS, Lin SD. Medial epicanthoplasty based on anatomic variations. J Plast Reconstr Aesthet Surg. 2012;65:1182–7.

    Article  Google Scholar 

  13. Guo L, Yuan F, Li B, Li JY, Wang CQ, Yan CH. Modified blepharosphincterectomy for congenital entropion in 24 cases. J Otolaryngol Ophthal Shandong Univ. 2014;28:77–8. In Chinese.

  14. Park JI. Modified Z-epicanthoplasty in the Asian eyelid. Arch Facial Plast Surg. 2000;2:43–7.

    Article  CAS  Google Scholar 

  15. Park JI. Z-epicanthoplasty in Asian eyelids. Plast Reconstr Surg. 1996;98:602–9.

    Article  CAS  Google Scholar 

  16. Hyakusoku H, Fumiiri M. The square flap method. Br J Plast Surg. 1987;40:40–6.

    Article  CAS  Google Scholar 

  17. Swan KC. The syndrome of congenital epiblepharon and inferior oblique insufficiency. Am J Ophthalmol. 1955;39:130–6.

    Article  CAS  Google Scholar 

  18. Kashima T, Katori N, Yamada T, Imagawa Y, Nakauchi K. Epicanthoplasty simultaneous with epiblepharoplasty in cases of epiblepharon with epicanthus. Nippon Ganka Gakkai Zasshi. 2010;114:105–9.

    PubMed  Google Scholar 

  19. Yan Y, Chen T, Wei W, Li D. Epiblepharon in Chinese children: relationships with body mass index and surgical treatment. J aapos. 2016;20:148–52.

    Article  Google Scholar 

  20. Woo KI, Yi K, Kim YD. Surgical correction for lower lid epiblepharon in Asians. Br J Ophthalmol. 2000;84:1407–10.

    Article  CAS  Google Scholar 

  21. Sundar G, Young SM, Tara S, Tan AM, Amrith S. Epiblepharon in East asian patients: the singapore experience. Ophthalmology 2010;117:184–9.

    Article  Google Scholar 

  22. Fujiwara T, Maeda M, Kuwae K, Nishino K. Modified split V-W plasty for entropion with an epicanthal fold in Asian eyelids. Plast Reconstr Surg. 2006;118:635–42.

    Article  CAS  Google Scholar 

  23. Wu S, Guo K, Xiao P, Sun J. Modifications of Z-epicanthoplasty combined with double-eyelid blepharoplasty in Asians. Aesthetic Plast Surg. 2018;42:226–33.

    Article  Google Scholar 

  24. Yoon K. Modification of Mustarde technique for correction of epicanthus in Asian patients. Plast Reconstr Surg. 1996;97:245.

    Article  CAS  Google Scholar 

  25. Oh YW, Seul CH, Yoo WM. Medial epicanthoplasty using the skin redraping method. Plast Reconstr Surg. 2007;119:703–10.

    Article  CAS  Google Scholar 

  26. Pfeiffer MJ. Surgical treatment of medial epicanthus by skin replacement. Klin Monbl Augenheilkd. 2016;233:50–3.

    Article  CAS  Google Scholar 

  27. Jung JH, Kim HK, Choi HY. Epiblepharon correction combined with skin redraping epicanthoplasty in children. J Craniofac Surg. 2011;22:1024–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Study concept and design (GL, SN), acquisition of data (LNH, HAJ), analysis and interpretation of data (LNH, HAJ, WD), drafting of the manuscript (LNH, SN), critical revision of the manuscript for important intellectual content (LNH, SN), administrative, technical, or material support, study supervision (GL, SN).

Corresponding authors

Correspondence to Lan Gong or Nan Song.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, N., He, A., Wu, D. et al. Skin redraping for correction of lower eyelid epiblepharon combined with medial epicanthal fold: a retrospective analysis of 286 Asian children. Eye 36, 844–849 (2022). https://doi.org/10.1038/s41433-021-01550-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-021-01550-w

Search

Quick links