Medial Epicanthoplasty

Medial Epicanthoplasty (Medial Epicanthal Correction)

Medial epicanthoplasty (medial epicanthal correction/medial epicanthoplasty) is a surgical procedure that excises and repositions the "Mongolian fold" (epicanthus tarsalis—a skin fold extending from the inner upper eyelid toward the inner corner of the eye) to make the lacrimal caruncle (the tear duct opening) visible from the outside. This fold, which is characteristic of East Asian eye shapes, is considered one of the factors that make the eyes appear smaller and more widely spaced. By incising this fold, the horizontal width of the eye is broadened, and the visibility of the lacrimal caruncle creates greater depth in the eye contour.

Principles and Surgical Techniques

Representative techniques include the "Z-epicanthoplasty," "W-method," "skin-redraping method," and "Y-V method." Each involves making a small incision at the inner corner of the eye and rearranging the skin flaps that comprise the fold to open the inner corner of the eye inward. Since the report on the Z-epicanthoplasty published in Plastic & Reconstructive Surgery (1996), surgical techniques have continued to be developed to achieve both inconspicuous scarring and natural results. The skin-redraping method published in Plastic and Reconstructive Surgery in 2007 (DOI: 10.1097/01.prs.0000246713.59153.bb) has become widely adopted as a minimally invasive technique that minimizes tissue excision by simply repositioning the skin.

Anatomical Characteristics of the Mongolian Fold

The Mongolian fold (epicanthus tarsalis) is commonly seen in East Asian populations, with an incidence of approximately 40% (Saudi Journal of Ophthalmology, 2023, DOI: 10.4103/sjopt.sjopt_54_22). In contrast, it occurs in only 2–5% of non-Asian populations. The more pronounced this fold, the more the inner corner of the eye is hidden, making both the vertical and horizontal dimensions of the eye appear smaller. Additionally, the presence of the Mongolian fold influences double eyelid formation and can hinder the creation of a parallel double eyelid line.

Standard Surgical Procedure

At our clinic, we perform the procedure according to the following steps.

Consultation and Design: We simulate your desired degree of eye opening and final appearance, then design the incision line.

Anesthesia: Local anesthesia (topical anesthesia plus injectable anesthesia) minimizes discomfort. Nitrous oxide anesthesia can be used concurrently upon request.

Incision and Flap Formation: We make a small incision (several millimeters) along the designed line and reposition and suture the skin flap. The procedure takes approximately 10–15 minutes per eye.

Suturing and Protection: We carefully suture with fine sutures, and the surgical site is stabilized with protective tape after the procedure.

Downtime and Recovery Course

Medial epicanthoplasty is an outpatient procedure performed under local anesthesia alone. While recovery varies from person to person, the typical course is as follows. Swelling and bruising peak 2–3 days after surgery and subside over 1–2 weeks. Suture removal is performed approximately 7 days after surgery. The final result typically stabilizes over 1–3 months, and scars mature over approximately 6 months. The 5-step method reported in BMC Ophthalmology (2025, DOI: 10.1186/s12886-025-04123-7) demonstrates that standardized procedures reduce variability among surgeons and yield consistent aesthetic results.

Scarring and Risk Management

Because the inner corner of the eye has thin skin and is a conspicuous area, scar management is an important consideration. A double-blind randomized controlled trial in Plastic & Reconstructive Surgery (2019, DOI: 10.1097/PRS.0000000000006069) demonstrated that early botulinum toxin A injection at the medial epicanthus (within 2 weeks post-surgery) significantly suppresses the formation of hypertrophic scars. We will propose an aftercare plan as needed. Additionally, revision surgery (reverse skin-redraping method) exists for patients who have previously undergone the procedure and are dissatisfied with the results. A 324-case series in Annals of Plastic Surgery (2017, DOI: 10.1097/SAP.0000000000000991) reported that the mean intercanthal distance improved from 33.6 mm to 36.9 mm after revision surgery, achieving favorable aesthetic outcomes.

Concurrent Double Eyelid Surgery

Medial epicanthoplasty is frequently performed simultaneously with double eyelid surgery (suture method or incision method), and combining both procedures allows creation of natural and harmonious eye shapes such as "parallel double eyelids." While the procedure can also be performed alone, the optimal combination will be confirmed during consultation based on the degree of Mongolian fold and your desired design.