To report the experience and advantageous effects of high-frequency radio wave electrocautery in modified Hotz operations for epiblepharon, We reviewed the records of all pediatric patients who underwent a modified Hotz operation with the use of high-frequency radio wave electrocautery (Ellman Surgitron Dual Frequency RF S5; Ellman International, Inc, Hewlett, NY) for epiblepharon between March 2016 and September 2019 at Korea University Guro Hospital. We evaluated the success rate, complications, recurrence rate and degree of satisfaction of our technique. Information from the medical records was collected, including demographics, ocular symptoms, severity of keratopathy, operation time, success/recurrence rate, and complications. 133 patients (98.52%) showed good correction of epiblepharon without complications or unpleasant cosmetic problems during 3 months of median follow-up period. Two patients (1.48%) showed recurrent corneociliary touch, but the degree was very mild and re-operation was not performed. One patient showed mild ectropion on his left lower eyelid, but the patient recovered well without operation. For complications, suture abscess and granulation were the most common, 3 cases in each, but all of those were temporary and resolved with conservative management. The approach with electrocautery for epiblepharon allows precise and fast incision of the lower eyelid, little bleeding, and minimal scarring. Surgical outcomes associated with the modified Hotz operation with electrocautery were consistent with previous studies.

Purpose: To analyze the change of direction of eyelashes after epiblepharon surgery using the Hotz procedure and to propose the appropriate correction amount to reduce the risk of undercorrection or overcorrection. Methods: Surgical correction using the Hotz procedure was performed in 60 patients who then were followed for 3 months in Korea University Anam Hospital. Clinical photographs were collected before and after the correction to measure the angle of the lower eyelashes. Result: The average angle before and after correction was 38.5° and −24.1°, respectively. The lower eyelashes gradually became introverted, and the amount of angle change was 9.3° at postoperative 1 month (P < 0.001). These lashes become slightly extroverted to −15.0° at 3 months after the correction. Conclusions: Lower eyelashes become introverted to about 9 degrees after surgical correction. They become more introverted after operation when the epiblepharon is more severe and when they are more reconditioned to extroversion immediately after the operation.