"Folding Fan Flap": A Novel and Dependable Surgical Technique for Crow's Feet Correction by Z-Plasty of Orbicularis Oculi Muscle

Objective: The challenge of crow's feet surgical correction is to minimize the complication caused by orbicularis oculi muscle (OOM) resection while ensuring the operative effect. This study aims to propose a novel technique to solve this problem and evaluate its efficacy.

Methods: From January 2022 to April 2024, all patients who received "Folding fan flap" in our institution were included. The outer third of the OOM below the lateral canthus was dissected and received Z-plasty to exchange width for length and reconstruct the muscle dynamics in a non-circular direction. Preoperative and postoperative smiling crow's feet were assessed by two independent physicians using the Lemperle wrinkle scale. At least six months after surgery, patient satisfaction with wrinkle correction, naturalness of facial expression, and local flattening was subjectively evaluated on a five-point scale. Complications including hematomas, incomplete eyelid closure, facial stiffness, and forehead numbness were recorded.

Results: A total of 32 patients (63 sides) were included with a mean follow-up of 13.9 ± 5.2 months. Postoperative assessments showed a significant reduction in Lemperle's score from 4.8 ± 0.4 to 1.5 ± 0.5 (P=0.000). Regarding the satisfaction of surgical outcomes and the naturalness of facial expressions, thirty patients (93.8%) were very satisfied. There were no severe complications such as hematomas and incomplete eyelid closure.

Conclusion: Preliminary clinical studies demonstrated the efficacy of this technique in ensuring outcomes while preserving normal dynamic expressions. By Z-plasty of the outer circle of OOM, the muscle dynamic was successfully modified rather than eradicated.

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