Case Study: Epicanthoplasty Revision (Restoration) and Double-Line Fold Lowering (1 Week Post-Op)

This is a case study of a patient who underwent two procedures simultaneously a few days ago.

The patient’s eyelid lines appear high—a condition commonly referred to as ‘sausage eyelids.’ Whether you call it sausage, sosage, or sosi-ji... well, anyway.

The lines look high, the fixation appears overly strong, and the eyelashes seem tilted upward.

However, when measuring the lines with the eyes closed, they are actually not that high. So why do they look high? It is because there is a lack of skin and significant scarring.

Furthermore, the caruncle (the pinkish flesh at the inner corner) is excessively exposed—nearly 100% visible. This happens when an epicanthoplasty is performed too aggressively.

Typically, Caucasians have no epicanthal folds at all.

Let’s look at an example:

In Caucasians, the caruncle is fully exposed. However, when an Asian eye is shaped this way, it looks very unnatural.

This is the view with the eyes closed. Compared to others, the line is actually low when the eyes are shut. However, when pinching the skin slightly with fingers, there was almost no excess skin available, particularly in the area indicated by the arrow.

The key was to create a new line below the existing one, thoroughly release the adhesions, and ensure that new adhesions do not form.

Pre-operative appearance. The lines are high and asymmetrical. One side (the patient’s left, right side of the photo) had particularly high fixation and more severe scarring.

One week post-op, immediately after stitch removal. Swelling is still present, but the lines have been successfully lowered. The caruncle is also much better covered. Significant swelling remains at this stage.

For more details on epicanthoplasty restoration, please refer to my paper published in 2019.

The patient’s right eye (left side of the photo) shows some bruising.

The upper arrow points to the previous eyelid line, which appears as a faint white mark. The lower arrow indicates the newly created eyelid line.

In epicanthoplasty restoration, the sutures should be slightly protruding; they will flatten out naturally over time.

For more information on the ‘double-line’ (fold lowering) technique, please refer to my other posts:

https://blog.naver.com/medicdoctor/222082578592

https://blog.naver.com/medicdoctor/222078309149

https://blog.naver.com/medicdoctor/221353621318

I tried making a video, but I am still a bit clumsy at it...

[Video — Refer to Original]

I hope the swelling subsides quickly and the results settle in beautifully.