New applied classification of epicanthus and algorithm for epicanthoplasty selection
目标: To present a classification-based clinical algorithm for selecting the surgical approach to Asian epicanthoplasty according to the epicanthal type, severity, and the patient’s desired degree of correction.
介绍: Asian epicanthal folds demonstrate considerable anatomical variability, while numerous surgical techniques have been described for their correction. However, the absence of a clinically oriented classification linked to surgical decision-making makes selection of the optimal technique challenging. We developed a clinical classification based on the level of attachment of the epicanthal fold to the upper eyelid and integrated it with epicanthal severity and the patient’s desired degree of correction to establish a practical surgical algorithm.
材料 / 方法: A retrospective analysis of preoperative photographs of 2,047 Asian patients who presented for surgical correction of epicanthal folds between 2002 and 2020 was performed. Epicanthal folds were assessed separately for each eye and classified according to their level of attachment to the upper eyelid as tarsal, infrapalpebral, or ciliary. Based on this classification, epicanthal severity, the patient’s desired degree of correction, and accumulated surgical experience, a decision-making algorithm was developed to guide the selection of the surgical approach.
结果: Three clinical types of epicanthal folds were identified: tarsal, infrapalpebral, and ciliary. Despite considerable morphological variability and the presence of intermediate variants, all epicanthal folds could be classified according to one of these three levels of attachment. The resulting algorithm provides a stepwise approach to surgical planning based on epicanthal type, severity, and the desired degree of correction, ranging from reduction of the fold with preservation of its natural features to complete correction involving its cutaneous, muscular, and ligamentous components.
总结: The proposed classification provides a clinically oriented framework for surgical planning in Asian epicanthoplasty. Integrating epicanthal type, severity, and the patient’s desired degree of correction enables a structured selection of the surgical approach while allowing flexibility in the choice of specific operative techniques.
