A multistage approach is usually recommended for the management of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES), with provision of adequate time between different complex stages. This video presents a single-stage surgery in a 3-year-old girl, where initial correction of palpebral phimosis started with a lateral canthotomy and canthoplasty, followed by correction of epicanthus inversus by Mustarde double Z-plasty, and telecanthus by bilateral shortening and posterior fixation of medial palpebral ligaments. Finally, correction of the vertical component (bilateral ptosis) was addressed by brow suspension using frontalis muscle flap advancement. Single-stage correction via multiple surgical steps leads to satisfactory functional and aesthetic outcomes in all 4 classical components. The 1-stage procedure has several advantages over a multistage procedure, such as a single surgical sitting, decreased hospitalization and recovery time, reduced exposure to general anesthesia, and cost-effectiveness, which effectively obviate the issue of loss to follow-up seen with multistage procedures in low-socioeconomic-status countries.

Financial Disclosure: Drs. Kasturi Bhattacharjee, Obaidur Rehman,Deepak Soni, and Vatsalya Venkatramandisclose no financial relationships.