title: A Modified Method Combining Z-Epicanthoplasty and Blepharoplasty to Develop Out-Fold Type Double Eyelids.
abstract: BACKGROUND
  The epicanthus can weaken the effect of blepharoplasty, which makes it difficult to form the out-fold type double eyelids preferred by Asian women. The integration of blepharoplasty and Z-epicanthoplasty has become increasingly popular. Although many techniques have been introduced to remove the epicanthus during blepharoplasty, there are still some surgical complications.
  
  
  METHODS
  This study aimed to evaluate the practicability and effectiveness of combining Z-epicanthoplasty and blepharoplasty. Removing a slice of skin from the upper eyelid to the inner canthus makes the epicanthus crease along the vertical axis of Z-plasty. The up-outward triangular flap points to the lower eyelid margin instead of the inner canthus. By cutting off the fibrous tissue and orbicularis oculi muscle, the tension that causes epicanthus is completely released; therefore, the inner canthus ligament anchor is unnecessary and avoids damage to the inner canthus.
  
  
  RESULTS
  From January 2008 to June 2014, this modified surgical method was carried out on 1108 patients. One hundred and twelve patients were evaluated at a follow-up visit ranging from 6 to 72 months. In 2 cases, the double-eyelid fold developed into an in-fold type, while, in 110 cases, it developed into an out-fold type. The outlines of the upper eyelids were natural and symmetric, and the inner canthus and lacrimal caruncle were fully exposed with no visible scar.
  
  
  CONCLUSIONS
  This modified method is simple in design and practice. The inner canthus and lacrimal caruncle can be fully exposed, giving a natural, smooth, Westernized, appealing look. This technique is suitable for all types of epicanthus in Asian women.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Jingyi
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Zuoliang
authors.initials: Z
authors.lastname: Qi
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Xianlei
authors.initials: X
authors.lastname: Zong
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Song
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
authors.forename: Le
authors.initials: L
authors.lastname: Du
authors.affiliation: Department No. 16. of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China. professor.jin@yahoo.com.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D019882:Blepharoplasty / Q000379:methods*; D005143:Eyelids / Q000033:anatomy & histology* / Q000601:surgery*; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D055815:Young Adult
keywords: Blepharoplasty; Out-fold type; Z-epicanthoplasty