The Modified Rectangle Flap Epicanthoplasty: A Novel and Individualized Design

  • Zhe Cao
  • Yong-Qiang Guo
  • Shen-Xing Tan
  • Chang-Ying Niu
  • Jing-Han Wang
  • Chun-Lei Miao
  • Sheng-Jian TangEmail author
  • Xiao-Qin LiangEmail author
Original Article Oculoplastic



The epicanthal fold is ordinary in the eyelids of Asians, and the aesthetic appearance of eyelid surgery could be reduced and undermined; thus, medial epicanthoplasty is commonly performed to eliminate the effect of the epicanthal fold with less scarring. At present, there are a lot of techniques that have been described for the treatment of epicanthal fold. The potential problems, however, such as visible scar or under correction in the medial canthus area are challenges to surgeons. The purpose of our study was to explore a novel and individualized design using a modified rectangle flap with acceptable functional and aesthetic outcomes.


From January 2017 to January 2018, epicanthoplasty was performed for 40 patients by using a modified rectangle flap. All patients underwent double-eyelid surgery at the same time when they needed it. The evaluation criteria included the intercanthal distance (ICD), interpupillary distance (IPD), the ratio of ICD to IPD (ICD ratio), scar visibility, and cosmetic results.


From January 2017 to January 2018, the modified rectangle flap method was carried out on 40 patients, who were evaluated at follow-up from 7 to 15 months. The average intercanthal length was 36.9 ± 2.2 mm preoperatively and decreased significantly to 31.5 ± 1.8 mm postoperatively, 7 months after the surgery (P < 0.01). The excellent cosmetic results, in terms of an open medial canthus, were observed during follow-up periods, with no definite recurrence, hypertrophic scar, or injury of the lacrimal apparatus. The inner canthus and lacrimal caruncle are fully exposed with an invisible scar. Both the patients and the surgeon judged that the aesthetic outcomes were excellent or good.


This modified rectangular flap is an effective and personalized method of correcting the medial folds that leave no additional scar in the medial canthal area, and the procedure meets the patient’s aesthetic expectations.

Level of Evidence IV

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


Epicanthoplasty Modified rectangle flap Invisible scar 



We thank all the authors for their efforts in this article. The PhD Start-up Fund of Weifang Medical College (2017BSQD35).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Zhe Cao
    • 1
  • Yong-Qiang Guo
    • 2
  • Shen-Xing Tan
    • 3
  • Chang-Ying Niu
    • 4
  • Jing-Han Wang
    • 1
  • Chun-Lei Miao
    • 1
  • Sheng-Jian Tang
    • 1
    Email author
  • Xiao-Qin Liang
    • 1
    Email author
  1. 1.Institute of Plastic SurgeryWeifang Medical UniversityWeifangPeople’s Republic of China
  2. 2.Department of OrthopedicsThe Eighty-Ninth Hospital of People’s Liberation ArmyWeifangPeople’s Republic of China
  3. 3.Department of Plastic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangPeople’s Republic of China
  4. 4.Department of DermatologyAffiliated Hospital of Weifang Medical UniversityWeifangPeople’s Republic of China

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