title: The Modified Z-Epicanthoplasty-A Stepwise and Individualized Design.
abstract: OBJECTIVE
  To describe a medial epicanthoplasty technique using a stepwise, customized design and to review the outcome in Asian patients after the treatment of medial epicanthal fold.
  
  
  METHODS
  Retrospective, noncomparative and interventional case series with the introduction of a new surgical technique.
  
  
  METHODS
  Forty-eight consecutive Asian patients with primary medial epicanthal fold.
  
  
  METHODS
  Patient charts were reviewed from patients (mean age, 24.6 ± 3.8 years; range, 19-40 years) with a stepwise z-epicanthoplasty. The intercanthal distance (ICD), interpupillary distance (IPD), and scar visibility were evaluated at regular intervals (preoperative, immediate postoperative, 3 months, 6 months, and 1 year after the operation). The ratio of the ICD to IPD (ICD ratio) was calculated, and the visibility of the surgical scar assessed.
  
  
  METHODS
  Postoperative improvement in ICD ratio and scar quality.
  
  
  RESULTS
  The preoperative median ICD ratio was 0.60 (range, 0.57-0.66) and decreased to 0.57 (range, 0.52-0.60) postoperatively. The median ICD ratio reduction was 5.6% (range, 2.6-14.1%; P < 0.001, Wilcoxon signed-rank test). Forty patients (83.3%) had no visible scarring or scarring only visible under close inspection. Eight patients (16.7%) experienced a more apparent scar, but none of them developed a severe scar requiring revision.
  
  
  CONCLUSIONS
  The modified z-epicanthoplasty using a stepwise design is a customized and effective technique for the treatment of the epicanthal fold. This method has a short learning curve, is widely applicable to various types of epicanthal fold, and has a high satisfaction rate with a stable long-term result.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; and †Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Dongze
authors.initials: D
authors.lastname: Lyu
authors.forename: Yunbo
authors.initials: Y
authors.lastname: Jin
authors.forename: Lei
authors.initials: L
authors.lastname: Chang
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Gang
authors.initials: G
authors.lastname: Ma
authors.forename: Wenxin
authors.initials: W
authors.lastname: Yu
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Lin
mesh_terms: D000328:Adult; D044466:Asian People; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies