Invited Discussion on: Revisiting Anchor Epicanthoplasty in Mild to Moderate Asian Epicanthal Folds: A Clinicopathologic
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Revisiting Anchor Epicanthoplasty in Mild to Moderate Asian Epicanthal Folds: A Clinicopathological Study Catherine J. Hwang1
Received: 23 August 2020 / Accepted: 24 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V 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 www.springer.com/00266. The authors [1] present their results using Lee’s anchor epicanthoplasty technique in an Asian Iranian population [2]. The new information here is that their population differs from that studied by Lee in that Asian Iranians tend to have a higher nasal bridge and less severe epicanthal folds. The authors also show histopathology of the excised tissue. The main strength of this paper regards the multitude of outcomes measures taken on digital photography. These objective measures showed that the anchor technique attained an excellent success rate in moderate folds, but that it was less successful in severe (grade 3) folds, improving only about of these cases. The authors believe the western Asian population may possess milder morphologic characteristics of eastern Asian eyelids, and use this as a basis for performing the anchor epicanthoplasty technique in their patient population. However, the degree of folds of both populations likely exists on a curve, and a grade 2 or threefold is likely similar among these different populations. Thus, the results confirm that anchor epicanthoplasty works well for moderate folds in both eastern and western Asian populations, but not as well for more severe folds in both populations.
& Catherine J. Hwang [email protected] 1
Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, OH 44195, USA
More severe fold in either population may benefit from other techniques. The authors used permanent sutures to anchor to the medial canthal ligament in this study, rather than absorbable sutures. While the skin of the medial canthus is thick, some of the underlying orbicularis muscle was removed, and one wonders whether these permanent sutures could erode through the skin, into the canalicular system or posteriorly through the conjunctiva. The follow-up interval of 13 months is not long enough to answer this question. While absorbable sutures may cause more inflammation, this should be temporary in most cases and may produce ultimately similar results without the permanent suture load. The authors detailed measurements included MRD1. Similar to other double-eyelid blepharoplasty studies, the authors found about a 1/3 mm increase in MRD1 after surgery. This may be from the supratarsal fixation of the double-eyelid aspect of the surgery and may be associated with at least temporary lagophthalmos in some patients. The authors did not provide any data regarding lagophthalmos, but
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