Root Z-epicanthoplasty

Table 7.1

Indications for surgery

Cosmetically displeasing epicanthal fold less than 5 mm
In combination with ptosis surgery, double upper eyelid crease formation or epiblepharon repair

Table 7.2

Preoperative evaluation

Desire for concurrent double eyelid surgery
History of prior hypertrophic scarring of skin or keloid formation after incisional surgery
Type of epicanthal fold present
No excess upper eyelid dermatochalasis or eyelid ptosis present
Discussion of complications related to scar formation and visibility of incision lines


The presence of an epicanthal fold with the absence of a supratarsal fold (double upper eyelid) is a common finding in the Asian patient. In patients without a prominent epicanthal fold, creation of a double eyelid ( Chapters 4 and 5 ) can create an aesthetically pleasing outcome. However, if a prominent epicanthal fold is not concurrently addressed during double eyelid surgery, the resulting outcome may appear suboptimal due to the apparent shortening of the horizontal palpebral fissure and widened intercanthal distance.

The classic technique to address epicanthal folds is Mustardé’s technique, as covered in Chapter 8 . Mustardé’s epicanthoplasty involves larger incisions and can more powerfully reduce congenitally anomalous epicanthal folds but may cause more visible scarring in the medial canthal region. The root Z-epicanthoplasty, has the benefit of smaller incisions, which are created with minimal wound tension and can be an excellent cosmetic adjunct during double eyelid surgery. The root Z-epicanthoplasty differs from the classic Z-plasty flap in that the angles of the Z are not equivalent. To allow for rearrangement of these flaps, judicious undermining is performed with conservative debulking of the subcutaneous fibrofatty tissues and orbicularis muscle fibers which constitute the epicanthal fold.

Surgical Technique

Figures 7.1A and 7.1B

Marking the base of the epicanthal fold

All markings are performed prior to infiltration of local anesthesia. If the skin is oily, an alcohol prep should be used to clean the skin surface. A topical anesthetic such as proparacaine can be given prior to cleansing of the skin surface and marking to reduce discomfort. Toothless forceps are used to first mark the base of the epicanthal fold to be addressed at the level of the lacrimal lake ( Figure 7.1A ). This is compared to the fellow eyelid and measured. In general the root Z-epicanthoplasty is ideally suited for reduction of less than a 5 mm epicanthal fold ( Figure 7.1B ).

May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Root Z-epicanthoplasty
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