[Duhan Plastic Surgery Eyelid Surgery] - [Epicanthoplasty, Medial Canthoplasty]

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What is epicanthic fold removal surgery?

When the space between the two eyes appears wide,

there are many cases where the skin at the inner canthus covers the eyeball excessively,

and the skin covering the eyeball from the inner side of the eye is called the epicanthic fold.

What is epicanthic fold removal surgery (medial canthoplasty)?

By removing the skin at the inner canthus,

it normalizes the distance between the eyes

and opens up the inner part of the eye that looks cramped.

DUHAN EYELID CLINIC

An epicanthic fold (inner canthal fold) is diagnosed when the distance between the eyes is 40 mm or more, or when the skin at the inner side of the eyes covers the whites of the eyes, creating a cramped appearance.

Eyes with an epicanthic fold usually have an inner eye corner that is not sharp and appears rounded or has a sharply downward angle.

​Epicanthic fold removal surgery (medial canthoplasty) principles

♥ There should be no scar left. : The incision line should be hidden inside the eyelid boundary so that scar formation is almost nonexistent.

♥ The shape should look natural. : The inner shape 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 there is no scarring in our epicanthic fold removal surgery (medial canthoplasty)

If the skin is incised, a scar will inevitably form.

The same applies to the epicanthic fold; since surgery is performed by making an incision, scarring is an unavoidable issue.

If the surgery exposes the scar on the surface, the scar can look unsightly no matter how carefully it is sutured.

However, if the scar line is hidden at the very edge of the eye corner, the scar will become almost unnoticeable.

In other words, because the scar is not exposed on the surface, it is not visible.

Indications for epicanthic fold removal surgery (medial canthoplasty)

1. When the distance between the eyes appears wide

In principle, surgery is performed when the distance between the inner canthi exceeds 40 mm.

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

If done incorrectly, the distance between the eyes can become too short and the eyes may look too close together.

2. When you want to create outfold double eyelids

If an epicanthic fold is present, an infold double eyelid is formed, so epicanthic fold removal is needed to create outfold double eyelids.

Comparison of the openly exposed scar from epicanthic fold removal surgery (medial canthoplasty) and our medial canthoplasty

The principles of epicanthic 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 Furukwa and Y-V methods.

The advantages are that the scar is less visible and the result looks natural, and when combined with double eyelid surgery, the epicanthic fold can be removed naturally along the extension of the double eyelid line.

Different epicanthic fold surgery methods and scar shapes

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

The principles of epicanthic 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 mainly use the Furukwa method shown in the lower right.

Its advantages are that the scar is almost invisible, the shape looks natural, and when combined with double eyelid surgery, the epicanthic fold can be removed naturally along the extension of the double eyelid line.

Surgical process of epicanthic fold removal

★ Steps 1 to 3: Pull the skin toward the nose. -> Design the planned incision line. -> Perform local anesthesia.

1. Pull the skin toward the nose to make it taut.
2. With the skin stretched, the design is drawn with special ink. The shape of the design varies depending on the surgical method, so it is not always the same.
3. While under sedation anesthesia, local anesthesia is administered to the design area.

★ Steps 4 to 6: Incise along the planned incision line. -> Lift the skin and dissect it from the muscle. -> Reposition the lifted skin.

4. Using a scalpel, a precise incision is made along the design line.
5. The skin is lifted away from the muscle.
6. The skin tissue is repositioned so that the epicanthic fold is pulled toward the nose. At this time, an appropriate amount of excess skin tissue is removed.

★ Step 7: Suture the skin.

| 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 epicanthic fold removal surgery (medial canthoplasty)

Postoperative care after epicanthic fold removal surgery (medial canthoplasty)

1. For follow-up after surgery, visit the next day so the surgical area can be disinfected and the progress monitored.
2. The stitches are removed on day 5 after surgery.
3. Swelling after surgery is minimal, and the period for everything to settle completely is about 1 to 3 months. During this period, the surgical area should not be rubbed strongly.
4. For about 3 months, a slight scar may be noticeable at the inner edge of the eye, but this is a normal process and after 3 months it becomes almost unnoticeable.
5. When washing your face, be careful not to rub the surgical area. If you rub the surgical area strongly, the scar may become messy or widen, so please be careful.

Precautions for epicanthic fold removal surgery (medial canthoplasty)

It should only be performed when it suits your own eye shape. During the consultation, you should carefully discuss with the specialist and decide whether epicanthic fold removal is truly necessary.
It is difficult to perform epicanthic fold removal surgery without leaving any scar, regardless of the method used. It is better to perform the surgery using a method that leaves minimal scarring, and it is advisable to hide the scar inside. Because the scar is not visible on the outside, there are almost no visible signs of surgery.

When epicanthic fold removal surgery (medial canthoplasty) should not be performed

1. When the distance between the eyes is less than 40 mm. A normal distance is usually about 36 to 37 mm. If it is less than 40 mm, epicanthic fold removal surgery should not be performed. If medial canthoplasty is performed on eyes with a normal distance, it can cause the eyes to look too close together, so caution is needed.
2. When the distance between the eyes is wide but the inner eye corner already has a sharp shape. Epicanthic fold removal surgery should not be performed. The goal of epicanthic fold removal is to open up the inner part of the eyes when the shape is rounded, but if the eyes are already sharply opened, the eye shape may become even more severe after surgery, so caution is needed.

What is medial canthoplasty restoration surgery?

It refers to surgery that restores the original eye shape after an unnecessary medial canthoplasty was performed despite it not being indicated,

and the impression became worse as a result.

DUHAN DOUBLEFOLD CLINIC

Reasons why medial canthoplasty restoration surgery is performed

If medial canthoplasty was done because it was necessary, whether restoration is needed again is something that must be carefully considered.

It occurs 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, so please keep this in mind.

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 eye corner is already sharp, the eye shape becomes sharper and the eyes look more severe.
3. The mucosa on the inner side of the eyes is excessively exposed and becomes unpleasant-looking.
4. After medial canthoplasty, the inner line becomes thicker, and if an infold line is desired, an unwanted outfold line is created.
5. A double eyelid revision was performed to reduce the inner line, but when combined with medial canthoplasty, the line does not become smaller or may even become larger.

Methods of medial canthoplasty restoration surgery

To restore the eye by designing it opposite to medial canthoplasty, methods such as the V-Y advancement flap or Z-plasty are used.

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

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

An example of medial canthoplasty restoration

Before undergoing medial canthoplasty restoration surgery, it is important to avoid creating a situation that would require it in the first place.

To make the impression worse through medial canthoplasty and then spend money and time on restoration surgery to reverse it is a waste of both cost and time.

You should carefully judge whether it is truly necessary for you before deciding.

How Duhan Plastic Surgery’s double eyelid revision clinic restores medial canthoplasty

Based on more than 20 years of rich clinical experience and know-how, if the medial canthoplasty is severe and restoration is desired, a one-stage procedure may be possible if the current double eyelids are natural and there is enough excess skin in the front. However, if there is not enough excess skin and the double eyelids are awkward and large, staged reconstructive plastic surgery may be necessary.

In general, if the double eyelid thickness (width) is around 6 mm or more, or if the fixation point of the double eyelid is very high, it may take a long time for the result to look natural.

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

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

Even if epicanthic fold reconstruction surgery is performed, the eyes cannot be exactly the same as before, and because the skin around the eyes must be gathered toward the eye area during reconstruction, care must be taken so that the scar does not spread downward on the inner side of the eye.

Because the scar is sutured from the inside of the skin, it does not form.

What is outer canthoplasty surgery?

These days, there are frequent cases of people complaining of side effects from outer canthoplasty performed at other hospitals.

Outer canthoplasty is the opposite of medial canthoplasty,

and refers to surgery that opens up the outer side of the eye.

Even in plastic surgery textbooks, outer canthoplasty is

described as a procedure that should not be performed.

If side effects occur, recovery is impossible,

and there are almost no ways to correct them, so this must be kept in mind.

DUHAN DOUBLEFOLD CLINIC

Types of outer canthoplasty side effects

1. Ectropion and lifting of the eyelid

2. Distorted scar at the outer corner of the eye

3. Mucosal exposure and drooping eyelids

4. Excessive exposure of the lower white of the eye

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

6. Dry eye syndrome and tearing

Examples of outer canthoplasty side-effect correction surgery at other hospitals

The outer canthoplasty photos below are of patients who came to our clinic for double eyelid revision consultation or treatment after having outer canthoplasty surgery at another hospital, in order to show the seriousness of outer canthoplasty side effects.

Duhan Plastic Surgery’s outer canthoplasty restoration method

It has recently gained attention because it compensates for the major drawback of conventional outer canthoplasty, which is re-adhesion.

Because tissue that tends to reattach is sufficiently removed through skin dissection, it does not reattach, and the inner conjunctiva of the eye is delicately sutured according to the anatomical structure, from the ligament-fascia layer to the muscle layer and the skin layer.

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

Also, unlike at other hospitals, it is not done with skin incision alone; by firmly fixing it to the periosteum, it does not come undone, and it is a safe procedure that can also be restored later.

The sutured area is naturally hidden along the eye-corner line, minimizing visible scars, and thanks to more than 20 years of extensive experience in double eyelid revision surgery,

the delicate and precise suturing leaves almost no scar.

Frequently asked questions and answers about the epicanthic fold

Question) What is an epicanthic fold?

Answer) An epicanthic fold is also called an “inner canthal fold,” and it refers to a condition in which there is too much skin at the inner part of the eye, blocking the white of the eye on the inside.

Usually, when an epicanthic fold is present, the eye shape looks cramped and the distance between the eyes appears wide.

Question) Will epicanthic fold removal surgery leave a scar?

Answer) Most epicanthic fold removal surgeries leave a small scar.

Many methods for epicanthic fold removal have been developed, but only a few are actually used in practice.

It is best to use a method that leaves as little scarring as possible and looks natural.

Since surgical methods differ by hospital, it is preferable to choose a method that leaves less scarring, has no recurrence, and produces natural results.

Question) Are epicanthic fold removal surgery and medial canthoplasty the same thing?

Answer) They mean the same thing.

Epicanthic fold removal surgery is also called inner canthal fold plastic surgery, and in common terms it is called medial canthoplasty.

They all mean the same thing.

However, outer canthoplasty is a procedure that opens the outer side of the eye, so it is the exact opposite of medial canthoplasty.

Question) Can double eyelid surgery and epicanthic fold removal surgery be done at the same time? Or should they be done separately?

Answer) The two surgeries can be done at the same time, or separately.

You can do the double eyelid surgery first and then epicanthic fold removal later, or do epicanthic fold removal first and then double eyelid surgery later. ​

How to avoid failures in eye plastic surgery and eye revision surgery?

As double eyelid surgery has become more common, cases of side effects or dissatisfaction due to indiscriminate surgery have increased.

In particular, people often tend to think of double eyelid surgery as a simple procedure.

However, since even slight differences in height or shape can create major changes in appearance, there are many cases of side effects, and double eyelid revision surgery is a difficult procedure.

To succeed with revision surgery, one must accurately understand what went wrong in the first surgery and how it should be improved.

Double eyelid revision surgery is quite complicated.

Revision surgery must include a delicate process of redesigning the new line and completely separating and dissecting the already adhered double eyelid tissue.

Through this careful dissection process, future problems such as a bumpy line or upward rolling due to adhesion must be prevented.

Also, not only the skin layer but every tissue in the fat layer and muscle layer must be neatly organized one by one to achieve a satisfactory result.

Double eyelid revision surgery cannot be perfected with analysis based on limited experience, and because the double eyelid line can lead to very different results with subtle 1-2 mm differences, accurate diagnosis is important—such as whether a sausage-like result, an overly high line that does not suit the face, incorrect eye correction, or scar correction is possible, and how much excess skin can be obtained.

Also, if a uniform double eyelid line is insisted upon simply because it is revision surgery, a perfect line suited to each patient will not be achieved.

Based on each individual’s double eyelid condition, one must consider gender, age, harmony with the overall face, and the patient’s wishes.

The height and shape of the double eyelid line (inline, in-out line, outline, etc.) should reflect the patient’s preference while creating a natural-looking change.

As new hospitals have sprung up one after another and perform double eyelid surgery indiscriminately, the number of patients seeking revision surgery has also increased, which is truly unfortunate.

If revision surgery fails after being performed multiple times, the excess skin becomes reduced, making the next revision surgery an even more difficult and extreme procedure.

Not only is the initial choice important for double eyelid surgery, but when considering revision surgery, it must be approached carefully, as if it will be the last chance.

http://www.doublefold.co.kr ​