Meta-analysis of the skin redraping method and the Z-plasty method in the correction of epicanthus

BACKGROUND: Epicanthus, a prevalent aesthetic concern in Asian populations, can be surgically corrected using various techniques. The skin redraping method and Z-plasty are 2 widely adopted approaches. This study aimed to conduct a systematic meta-analysis to comprehensively compare the clinical efficacy and outcomes of these 2 dominant surgical methods for epicanthus correction. METHODS: A systematic literature search was performed across PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases from their inception through December 2025. Randomized controlled trials (RCTs) and cohort studies directly comparing skin redraping and Z-plasty for congenital epicanthus were eligible. Primary outcomes included postoperative change in intercanthal distance (ICD), scar assessment via the Vancouver Scar Scale at 6 months, patient satisfaction, recurrence rate, and incidence of complications. Study quality was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. Statistical synthesis was performed using Review Manager 5.4 and R metafor package, employing fixed-effect or random-effects models based on heterogeneity (I2 statistic). RESULTS: Fourteen studies (1539 patients) were included. All included studies were published in Chinese. Meta-analysis showed no significant difference in postoperative ICD reduction (mean difference = 0.56 mm, 95% confidence interval [CI]: -1.20 to 2.33, P = .53, I2 = 98%). Z-plasty yielded significantly better 6-month Vancouver Scar Scale scores (mean difference = 0.44, 95% CI: 0.31-0.57, P < .00001) and higher patient satisfaction (odds ratio [OR] = 0.39, 95% CI: 0.18-0.84, P = .02). Recurrence was significantly lower with Z-plasty (OR = 13.73, 95% CI: 2.53-74.49, P = .002), although this analysis was based on only 3 studies. Complication rates were similar (OR = 1.45, 95% CI: 0.65-3.23, P = .36). CONCLUSION: Both techniques effectively reduce ICD with comparable safety. Within the limited follow-up period of the included studies (up to 6 months), Z-plasty was associated with better scar appearance, higher satisfaction, and lower recurrence. The high heterogeneity and exclusive inclusion of Chinese studies necessitate cautious interpretation. Future multicenter RCTs with longer follow-up and standardized technique reporting are warranted.