Introduction

The excision of epicanthus in the eyes is a specialized ophthalmic and aesthetic surgical procedure. New York City, being a major medical hub, is home to numerous public and private hospitals that offer such procedures. In this article, we will explore the ranking of these hospitals, understand the techniques used for epicanthus excision, and delve into various related aspects to help patients make informed decisions.

Understanding Epicanthus and Its Excision

Epicanthus is an uneven distribution of skin, involving the orbicularis oculus and medial canthal structures, that partially covers the medial corner of the eye. This condition is more prevalent in the Asian population, where it can range from 40% to 90%, compared to 2% - 5% among non - Asians. Epicanthoplasty, the surgical procedure to excise epicanthus, is often a voluntary aesthetic procedure. It aims to eliminate the epicanthal folds, lengthen the inner part of the eye, and create a bigger, brighter eye appearance. It is frequently performed in conjunction with Asian double eyelid plasty as the epicanthus can limit the cosmetic outcome of eyelid plasty.

Pre - operative Evaluation

Before the surgery, a comprehensive pre - operative evaluation is essential. The severity of epicanthus is determined by the covered extent of the lacrimal lake and the width of the epicanthal fold. Mild epicanthus is defined when less than half of the lacrimal lake is covered and the width of the epicanthal fold is less than 2 mm. Moderate epicanthus occurs when more than half but not the entire lacrimal lake is covered and the width is between 2 - 4 mm. Severe epicanthus is when the lacrimal lake is completely covered by the fold that curves laterally to fuse with the lower eyelid and the width is greater than 4 mm.

Surgical Preparation

The patient is placed in a supine position for the procedure. Broad - spectrum antibiotics, along with sedatives like 1.5 to 2 mg alprazolam (Xanax) and pain medications such as propoxyphene na psylate–acetaminophen, 100/650 mg (Darvocet N - 100) may be administered. The patient is then put under sedation. The skin is given a sterile preparation before markings are made using an extra - fine marking pen to avoid asymmetric markings between the eyes. A local anesthesia solution of two percent lidocaine with 1:200,000 epinephrine, buffered with sodium bicarbonate in a 1:10 ratio, is administered to the eyelid after markings.

Techniques for Epicanthus Excision

There are several surgical techniques for epicanthus excision, each with its own advantages and disadvantages.

V - W Plasty

In the V - W plasty, a vertical w - shaped wound is created medial to the medial canthus. The central point of the w is then split as a v towards the medial canthus. However, this technique has some drawbacks. It requires multiple incisions, exposes scars, and is more likely to result in hypertrophic scars.

Horizontal Incision Method

The horizontal incision method involves making a horizontal incision from the most medial part of the lacrimal lake to a point on the epicanthal point perpendicular to the starting point. The extra skin fold gathered from the prior incision is removed. One of its limitations is that it only releases the epicanthal tension in the muscular layer and not the skin layer, and there is a higher rate of epicanthal recurrence.

Z - Plasty

Z - plasty is a technique where a z - shaped incision is made to create two triangular skin flaps. One flap contains most of the skin from the epicanthal fold, and the other has the skin from the medial canthal area. The two flaps are transposed, and the excess skin is trimmed off. But it can lead to redundancy of the pretarsal skin near the medial canthus, convergence of a pretarsal double fold toward the lacrimal lake. It also has challenges in design, prominent scarring of the medial canthal and nasal area, recurrence due to excessive tension force, and limited flexibility in application.

V - Y Advancement

A horizontal incision is made from the edge of the epicanthal fold at the level of the mid - caruncle to the outer surface of the epicanthal fold. Then the nasal skin is pulled medially to expose the lacrimal fold. The excess orbicularis oculi muscle and adhesion bands are removed, and a V flap is advanced to repair the defect. The cosmetic outcome of this method can be limited by the space between the lateral canthus and the lateral bony orbital wall. Similar to Z - plasty, it has difficulties in design, prominent scarring, and potential recurrence due to tension.

Subcutaneous Epicanthoplasty

This technique is often performed in conjunction with blepharoplasty. The orbicularis muscle and underlying fibrofatty tissue in the epicanthal fold are excised and debulked through the medial edge of an eyelid crease incision. The skin is then tacked down with absorbable sutures. It can typically only soften but not completely eliminate the epicanthal fold.

Ranking of Hospitals in New York City for Epicanthus Excision

Several hospitals in New York City offer procedures for epicanthus excision. Rankings of these hospitals can be determined based on multiple factors such as patient outcomes, nurse staffing, services, and the experience of the medical staff. Here are some of the top - ranked hospitals and their ophthalmology scores according to U.S. News:

New York - Presbyterian Hospital - Columbia and Cornell

This hospital is nationally ranked in 14 adult specialties and 10 pediatric specialties. It has shown high - performing results in ophthalmology. With a well - established team of ophthalmologists and access to advanced medical technologies, it offers a comprehensive approach to epicanthus excision. The hospital's focus on research and innovation also ensures that patients receive the latest and most effective treatment options.

New York Eye and Ear Infirmary of Mount Sinai

Ranked #12 in ophthalmology hospitals, it is nationally ranked in 1 adult specialty. The hospital has a long - standing reputation for its expertise in eye - related surgeries. Their team of surgeons is well - versed in the different techniques for epicanthus excision and can provide personalized treatment plans based on the patient's specific needs.

Manhattan Eye, Ear & Throat Hospital

It is nationally ranked in 9 adult specialties. The hospital has a dedicated ophthalmology department that offers a range of services, including epicanthus excision. Their experienced staff and state - of - the - art facilities contribute to its good standing in the field of ophthalmology.

NYU Langone Hospitals

National rankings include 14 adult specialties and 3 pediatric specialties. NYU Langone Hospitals have a multidisciplinary approach to patient care. In the context of epicanthus excision, they can combine the expertise of plastic surgeons and ophthalmologists to achieve optimal results. Their commitment to patient safety and satisfaction is also a significant factor in their ranking.

Post - operative Care and Complications

Post - operative Care

After the epicanthus excision surgery, post - operative care is crucial for a successful recovery. Generally, the patient is placed in a semi - reclined position immediately after the operation. A moist gauze is placed over the eyelid, followed by an ice pack. The ice pack is tied around the head or looped around the ear to keep it in place. The patient is advised to rest for 30 minutes to an hour before discharge. Usually, an additional dose of narcotic medication is sufficient for pain control. After discharge, the patient may take antibiotics for 2 days. The ice pack is applied in 30 - minute intervals on and off for the first 2 to 3 days. After that, hot compresses may be used to increase blood flow to the incisional areas and decrease erythema. The first postoperative visit is typically scheduled a week after surgery. Patients can return to work with shaded glasses during the first week after discharge. Contact lens wearers are recommended to switch to regular glasses during the recovery period, and vigorous exercises are usually allowed after 2 weeks.

Post - operative Complications

Unnatural appearance and visible medial scar formation are among the undesirable outcomes of epicanthus excision. Complications can occur due to poor procedural design and lack of precision in dissection. Incomplete flap elevation can cause blunting of the medial canthal area and persistence of the epicanthal fold. Permanent anchoring sutures on the superficial layer may result in suture migration, erythema, granuloma formation, suture abscess, and visible scarring. Skin closure under tension is the most common cause of thick scar formation, which can be due to incomplete flap elevation. Temporary epiphora caused by obstruction of the lacrimal sac from swelling is common but usually resolves within a couple of weeks. There is also a risk of damage to the lacrimal sac due to its proximity to the surgical site. Moreover, asymmetry between the eyes is frequently seen.

Factors to Consider When Choosing a Hospital

When choosing a hospital for epicanthus excision in New York City, patients should consider the following factors:

• Reputation and Rankings: As seen from the U.S. News rankings, hospitals with higher scores and more national rankings in relevant specialties are generally more likely to provide high - quality care. For example, New York - Presbyterian Hospital - Columbia and Cornell's extensive national rankings suggest its broad - based expertise in various medical fields, which can be beneficial for patients.
• Surgeon's Experience: The experience of the surgeons performing the epicanthus excision is crucial. Patients should inquire about the number of similar procedures the surgeon has performed and their success rates. Experienced surgeons are more likely to handle any unexpected situations during the surgery and achieve better aesthetic results.
• Range of Services: A hospital that offers a comprehensive range of services related to epicanthus excision, such as pre - operative consultations, post - operative follow - up, and additional support services like psychological counseling, can provide a more seamless patient experience. For instance, NYU Langone Hospitals' multidisciplinary approach ensures that patients have access to different types of medical expertise.
• Cost and Insurance Coverage: The cost of the procedure and whether it is covered by insurance should be carefully considered. Different hospitals may have different pricing structures, and patients should understand what is included in the cost, such as surgical fees, anesthesia fees, and post - operative care costs. Some insurance plans may cover part or all of the cost if the procedure is deemed medically necessary.
• Patient Reviews: Reading patient reviews can provide insights into the actual experiences of others who have undergone epicanthus excision at a particular hospital. Reviews can highlight aspects such as the quality of care, communication with the medical staff, and the overall satisfaction of the patients.

Conclusion

In conclusion, New York City offers a wide range of public and private hospitals for epicanthus excision in the eyes. Understanding the different surgical techniques, the importance of pre - operative evaluation and post - operative care, and the ranking of hospitals based on various factors is essential for patients considering this procedure. The hospitals mentioned, such as New York - Presbyterian Hospital - Columbia and Cornell, New York Eye and Ear Infirmary of Mount Sinai, Manhattan Eye, Ear & Throat Hospital, and NYU Langone Hospitals, have established themselves as leading institutions in the field of ophthalmology. However, patients should carefully weigh the different factors when choosing a hospital to ensure they receive the best possible care.

If you are considering epicanthus excision in New York City, take the time to research and visit the hospitals, consult with the surgeons, and understand all aspects of the procedure. Share this article with others who may be interested in learning more about epicanthus excision and the top - ranked hospitals in New York City.