The Boomerang Epicanthoplasty: A Technique That Avoids Hooding

Abstract

Redraping is an increasingly common epicanthoplasty method. However, hooding usually remains at the medial part of the upper eyelid. The authors innovated a modification of redraping epicanthoplasty using excision, resulting in a boomerang-shaped defect that does not lead to hooding of the medial upper eyelid.

Medial line (M-line) was drawn at the most medial point of the palpebral fissure. The canthus point (C-point) was marked approximately 1 to 3 mm laterally from the M-point, depending on the amount of widening needed. From the C-point, upper incision was designed to meet the double eyelid line. A V-shaped lower incision was designed 3 to 4 mm below the ciliary margin. A flap was elevated about 7 mm superiorly, 10 mm medially, and 5 mm inferiorly. The elevated skin flap was redraped and the M’-point, which reflected the M-point on the redraped skin, was marked. A curvilinear incision line reflecting previous incision lines was drawn. The crescent-shaped excess skin was excised and the medial canthus was retracted medially, and then the boomerang-shaped defect was observed. The M-point and M’-point were coapted with a suture. The dog-ear at the lower side was trimmed.

The 525 patients were followed up for ≥3 months postoperatively. The average increase in the palpebral fissure length was 1.2 ± 0.5 mm. The average decrease in the interepicanthal distance was 2.4 ± 0.9 mm. The average satisfaction score was 4.6 ± 0.6.

Boomerang epicanthoplasty can prevent hooding on the medial aspect of the upper eyelid. It is easy to design, requires marking only 1 point, and is tension-free, thereby reducing scar widening.