Closure of a round skin defect may be accomplished in several ways. When there is laxity in the surrounding skin, the wound edges are simply approximated in a straight-line closure. More often, some undermining of skin margins is necessary to reduce tension at the suture lines; dog-ears that form on either extremity of the line of closure are excised and discarded.

A straight-line scar contracture crossing the valley of the medial canthal area is more likely to bowstring and simulate an epicanthal fold. In some instances, therefore, a small skin defect in this region is allowed to heal secondarily. The residual scar may not appear too distracting. In other instances, wound contraction and spontaneous epithelialization are protracted events, and there is always some risk of displacing the lacrimal punctum or everting the eyelid. A split-thickness skin graft or a forehead transposition flap may be acceptable alternatives, despite differences in color match or thickness of skin.

I prefer the V-Y-S-plasty as a procedure for repair of round skin defects that do not lend themselves to direct approximation of the skin margins without disturbing the neighboring structures of the eyelids. It is a simple procedure that conserves tissue and avoids skin undermining.

This technique also has been employed in other areas of the face and has been found to be effective in avoiding disfigurement of symmetrical or paired structures. In addition, this technique has been adapted for the extremities, where the integument tends to be tense.