Doc, Do I Need Operation on My Epicanthal Fold (aka epicanthoplasty, 開眼角) ? - Part 7

So the answer to the question "Doc, do I need operation on my epicanthal fold?" depends on the patients' goals. If the patients just want the eyes to look brighter and bigger, double eyelid surgery alone is all that is needed. If the patients want the eyes to appear longer medial epicanthoplasty can be performed provided that the patients know the eyes will appear closer together and the down time longer as scars from epicanthoplasty take awhile to fade.

Double eyelid surgery without epicanthoplasty in 

a patient without previous surgery.

Double eyelid surgery without epicanthoplasty in a patient 

with failed suture technique done elsewhere.

However, there are exceptions to the rule and I usually recommend epicanthoplasty for the following:

a. Patients with unsightly epicanthal folds after previous double eyelid surgery especially if the epicanthal folds are asymmetrical.

Patient with previous double eyelid surgery and asymmetrical epicanthal folds (left). 

After epicanthoplasty the two eyes appear more balanced (right) 

although she also has some skin crease asymmetry.

b. Patients who want parallel skin creases. The presence of epicanthal folds may interfere with the creation of parallel creases making epicanthoplasty necessary.

Epicanthoplasty performed to create parallel skin creases.

Epicanthoplasty combined with double eyelid surgery 

to create parallel skin creases.

Another parallel skin creases created with combined epicanthoplasty.

c. Patients with prominent epicanthal folds especially of type III or IV which make the eyes appear squinting. Double eyelid surgery alone can sometimes make the squinting appearance worse. Epicanthoplasty, through exposure of more eye white medially, can correct the problem.

This patient complains of squinting appearance (pseudo-squint) after 

double eyelid surgery done elsewhere (top). This appearance is caused 

by epicanthal folds covering the eye whites. By pulling the epicanthal

 folds medially, the squinting appearance can be corrected (bottom).

A patient with pseudo-squint, double eyelid surgery combined 

with epicanthopasty not only make the eyes bigger 

but also correct the pseudo-squint.

Doc, Do I Need Operation on My Epicanthal Fold (aka epicanthoplasty, 開眼角) ? - Part 6

As mentioned earlier, the choice of technique is very important in epicanthoplasty as the procedure is done in the inner corner of the eye which is prone to scarrings. Cuttings near the eyelid margin reduces are associated with less scarrings and faster recovery. Skin draping epicanthoplasty as shown here is an ideal technique. 

Technique of skin redraping that cuts near the lid margin 

and produces less scars.

Pictures showing before (left) and 3-week post (right) bilateral 

double eyelid surgery and skin redraping epicanthoplasty.

Pictures showing before (left) and 2 -week post (right) bilateral 

double eyelid surgery and skin redraping epicanthoplasty.

Pictures showing before (left) and 4-week post (right) bilateral 

double eyelid surgery and skin redraping epicanthoplasty.