[Dohan Plastic Surgery Eye Surgery] - [Epicanthoplasty, Medial Canthoplasty]

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Scarless epicanthal fold removal - Medial canthoplasty

When the space between the eyes appears wide

In many cases, skin at the inner corners of the eyes excessively covers the eyeball,

and the skin covering the eyeball from the inner side of the eyes is called the epicanthal fold.

Epicanthal fold removal surgery (medial canthoplasty) means

removing the skin at the inner canthus,

normalizing the distance between the eyes,

and opening up the cramped-looking inner corners of the eyes.

An epicanthal fold (inner canthal fold) is diagnosed when the distance between the eyes is over 40 mm, or when the skin at the inner corners of the eyes covers the whites of the eyes, creating a cramped feeling.

Eyes with an epicanthal fold usually have inner corners that are not sharp, and are often rounded or have a steep downward angle.

The three principles of epicanthal fold removal surgery (medial canthoplasty)

There should be no scar

The incision line should be hidden inside the border of the eyelid so that scarring is almost nonexistent.

It should look natural

The inner corner of the eye should be designed horizontally so that the medial canthoplasty looks natural.

It should not recur

The inner corner should be fixed and sutured to the ligament so that it does not return to its original position.

Why scars do not occur in our medial canthoplasty

Whenever the skin is incised, scars inevitably form.

The same applies to epicanthal fold surgery, which requires an incision, so scarring is unavoidable.

If the surgery is done in a way that exposes the scar externally, it can look unattractive no matter how precisely it is sutured.

However, if the scar line is buried at the edge of the eye corner so that it is covered, the scar becomes barely noticeable.

Because the scar is not exposed on the surface, it is not visible.

Indications for epicanthal fold removal surgery (medial canthoplasty)

1. When the distance between the eyes appears wide

As a rule, surgery is performed when the distance between the inner corners of the eyes exceeds 40 mm.

The normal distance between the eyes is about 36 to 37 mm, but if the distance is normal and there is still an epicanthal fold, it is better not to perform the surgery.

If not done carefully, the space between the eyes may become too short, making the eyes look too close together.

2. When you want to create an out-fold double eyelid

If an epicanthal fold exists, an in-fold double eyelid is formed, so epicanthal fold removal is needed to create an out-fold double eyelid.

Comparison between externally exposed medial canthoplasty scars and the medial canthoplasty at Dohan Plastic Surgery Clinic

The principles of epicanthal fold removal surgery (medial canthoplasty) are that it should leave minimal scarring, have a low recurrence rate, and be a method that can be performed together with double eyelid surgery. At our clinic, we perform surgery using the Furukawa and Y-V methods.

The advantages of the surgery are that the scar is barely visible, the shape looks natural, and when performed together with double eyelid surgery,

it has the advantage of naturally extending the double eyelid line.

Various epicanthal fold removal methods and the shape of scars

Many different methods have been developed and used, but only a few are actually used in practice.

The principle of epicanthal fold removal surgery (medial canthoplasty) is that it should leave little scarring, have a low recurrence rate, and be a method that can be performed together with double eyelid surgery.

We mainly apply the Furukawa method shown in the lower right.

The advantages are that the scar is almost invisible, the shape looks natural, and when performed together with double eyelid surgery,

it has the advantage of naturally removing the epicanthal fold as an extension of the double eyelid line.

Medial canthoplasty procedure

1. The skin is pulled toward the nose to make it taut.

2. With the skin pulled taut, the design is marked with special ink.

The shape of the design varies depending on the surgical method, so it is not always the same.

At our clinic, we mainly use the Y-V method to keep the scar from being noticeable.

3. Under sedation anesthesia, local anesthesia is administered at the designed area.

4. A scalpel is used to make a precise incision along the design line.

5. The skin is lifted away from the muscle.

6. The skin tissue is rearranged so that the epicanthal fold is pulled toward the nose.

At this time, an appropriate amount of the remaining skin tissue is removed.

7. The skin is sutured with fine thread.

No separate bandage is needed immediately after surgery, and the stitches are removed after 5 to 6 days.

Before-and-after photos of epicanthal fold removal surgery (medial canthoplasty)

Postoperative care after epicanthal fold removal surgery (medial canthoplasty)

① After surgery, return the next day to disinfect the surgical site and monitor progress.

② Remove the stitches on the 5th day after surgery.

③ Swelling is minimal after surgery, and the final settling period is about 1 to 3 months. During this period, do not rub the surgical site vigorously.

④ A slight scar may be visible at the inner edge of the eye for about 3 months, but this is a normal process, and after 3 months it becomes barely noticeable.

⑤ When washing your face, be careful not to rub the surgical site. If you rub it hard, the scar may become messy or widen.

Precautions for epicanthal fold removal surgery (medial canthoplasty)

1. It should only be performed when it suits your own eye shape.

During consultation, you should carefully consider whether epicanthal fold removal is truly necessary and decide after discussing it with the specialist.

2. No matter which method is used, it is difficult to perform epicanthal fold removal surgery without leaving any scar at all.

It is better to operate in a way that leaves as little scarring as possible, and it is advisable to perform the surgery in a way that hides the scar inside.

Because the scar is not visible on the surface, there are almost no visible traces of surgery.

Cases in which epicanthal fold removal surgery (medial canthoplasty) should not be performed

1. If the distance between the eyes is less than 40 mm, the normal distance is usually about 36 to 37 mm.

If it is less than 40 mm, epicanthal fold removal should not be performed.

If medial canthoplasty is performed on eyes with a normal distance, a side effect may occur in which the eyes appear too close together, so caution is needed.

2. If the distance between the eyes is wide but the inner corner of the eye has a sharp shape, epicanthal fold removal should not be performed.

The goal of epicanthal fold removal is to open up the inner corners when they are rounded, making them look more refreshed.

If the eye is already sharply opened, surgery may make the eyes look even more severe, so caution is needed.

Medial canthoplasty restoration surgery

This refers to surgery performed to restore the original eye shape after having medial canthoplasty even though it was not actually indicated, which instead made the expression look worse.

Why medial canthoplasty restoration surgery is needed

If medial canthoplasty was done because it was thought to be necessary, you should consider whether medial canthoplasty restoration is now needed.

This happens when medial canthoplasty is recommended unconditionally without considering the eye shape after surgery.

If medial canthoplasty is performed when it is not indicated, various problems can occur.

Problems that can occur after unnecessary medial canthoplasty

① The distance between the eyes becomes shorter than normal, making the eyes look too close together.

② If medial canthoplasty is performed when the inner corner is already sharp, the eye shape becomes sharper and the eyes look more severe.

③ The mucosa at the inner corner of the eye becomes too exposed, creating an unpleasant appearance.

③ After medial canthoplasty, the inner line of the eye becomes thicker, so if an in-fold line was desired, an unwanted out-fold line may result.

⑤ Even after double eyelid revision surgery to reduce the inner line, if it is done together with medial canthoplasty, the line may not decrease or may become even larger.

How medial canthoplasty restoration surgery is performed

The restoration is done using a design opposite to medial canthoplasty, and methods such as the V-Y advancement flap or Z-plasty are used.

The method applied varies depending on the shape of the individual’s eye and the amount of available tissue.

Restoration surgery leaves more scars than medial canthoplasty, so this must be taken into account before proceeding.

Examples of medial canthoplasty restoration surgery

Before undergoing medial canthoplasty restoration, it is important not to create a situation that would require restoration in the first place.

Having medial canthoplasty because it made the impression worse, and then paying to reverse it, is a waste of both money and time.

You should carefully judge and decide whether it is truly necessary for you.

With more than 20 years of extensive clinical experience and expertise, if medial canthoplasty was performed too aggressively and restoration is desired, it may be possible to do it in one stage if the current double eyelids are natural and there is enough skin laxity at the front. However, if there is not enough skin laxity and the double eyelids are awkward and large, staged reconstructive plastic surgery may be necessary.

In general, if the thickness (width) of the double eyelid is around 6 mm as a standard and is much larger than that, or if the fixation position of the double eyelid is very high, it may take a long time before it looks natural.

Reconstruction can be performed to suit the shape of your own eyes.

It takes about 1 to 3 months for swelling to subside and for the result to settle.

Even if you undergo epicanthal reconstruction surgery, it cannot be exactly the same as your old eyes, and because the skin around the eyes must be gathered toward the eye area during reconstruction, care must be taken to prevent the scar from opening below the inner corner of the eye.

The scar does not form because the inside of the skin is sutured.

Lateral canthoplasty

These days, due to lateral canthoplasty performed at other hospitals,

there are frequent cases of people complaining of side effects.

Lateral canthoplasty, unlike medial canthoplasty,

is a surgery that opens the outer corner of the eye.

It is one of the surgeries that should absolutely not be performed in plastic surgery.

It is a procedure that is even stated in plastic surgery textbooks as something better not done.

Lateral canthoplasty can cause mucosal exposure, eyelid ectropion,

sharp eye shape, severe scarring, and other

various side effects.

The side effect rate of lateral canthoplasty is over 90%,

and it can create irreversible, serious complications, so caution is needed.

Types of lateral canthoplasty side effects

1. Eyelid ectropion and lifting

2. Distorted scars at the outer corner of the eye

3. Mucosal exposure and eyelid drooping

4. Excessive exposure of the lower white of the eye

5. Deformation of the eye shape and distortion of the outer canthus

6. Dry eye and tearing

Examples of lateral canthoplasty side effects at other hospitals

The lateral canthoplasty photos below are a collection of photos from people who came to our clinic to show the seriousness of lateral canthoplasty side effects,

as well as photos of people who came for surgery after having lateral canthoplasty at other hospitals.

Lateral canthoplasty has recently gained attention because it compensates for the drawback of previous lateral canthoplasty side effects, namely reattachment.

Because adhesions are sufficiently removed through skin dissection, it does not reattach, and the surgery delicately sutures from the inner conjunctiva of the eye to the ligament-fascia layer, muscle layer, and skin layer in accordance with anatomical structure.

Because the skin and mucosa are sutured separately, it does not form a "D" shape, and there is no concern about reattachment.

In addition, unlike at other hospitals, it is not performed with skin incision alone; by firmly fixing it to the periosteum, it does not come undone,

and it is also a safe surgery that can later be reversed.

The sutured area is naturally hidden along the eye corner line to minimize externally visible scarring, and thanks to more than 20 years of extensive expertise in double eyelid revision surgery,

delicate and precise suturing leaves almost no scar.

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