title: Invisible scar medial epicanthoplasty: A novel approach.
abstract: BACKGROUND
  Presently, many techniques have been described to make the epicanthal fold less prominent. However, visible scarring remains a major concern in most techniques. The aim of this study was to develop a novel design using concealed incisions with minimal tension.
  
  
  METHODS
  Between December 2010 and May 2015, charts were reviewed from patients who underwent a concealed incision and tension-free technique to correct the epicanthal fold. The intercanthal distance (ICD), interpupillary distance (IPD), scar visibility, and cosmetic results were evaluated preoperatively and 1 year after the surgery. The ratio of the ICD to IPD (ICD ratio) was calculated, and the visibility of the scar was assessed.
  
  
  RESULTS
  In total, 136 patients (mean age 25.2 ± 2.7 years, range 20-32 years) were included. The preoperative median ICD ratio was 0.60 (range, 0.54-0.68) and decreased to 0.54 (range, 0.48-0.62) postoperatively. The median ICD ratio reduction was 9.1% (range, 3.6%-22.0%; P < 0.001, Wilcoxon signed-rank test). One hundred and thirty-four patients (98.5%) had no visible scarring or minimal scarring visible only under close inspection. Two patients (1.5%) experienced a more prominent scar, but none of them developed a severe scar requiring revision. The aesthetic outcome judged by the patient and surgeon was excellent or good in all cases.
  
  
  CONCLUSIONS
  From our experience, the scar after medial epicanthoplasty can be minimized by using a concealed incision and tension-free technique. Our technique is an effective and individualized method, leading to a high satisfaction rates.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China.
authors.forename: Yunbo
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China; Department of Plastic Surgery, The Second Affiliated Hospital of Nanjing Medical University, China.
authors.forename: Dongze
authors.initials: D
authors.lastname: Lyu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ma
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China.
authors.forename: Yajing
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zou
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tremp
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, China. Electronic address: linxiaoxi@126.com.
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Lin
mesh_terms: D000328:Adult; D044466:Asian People; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D002681:China; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D055815:Young Adult
keywords: Asian blepharoplasty; Double eyelid; Epicanthoplasty; Epicanthus; Eyelid evolution