Doc, Do I Need Operation on My Epicanthal Fold (aka epicanthoplasty, 開眼角) ? - Part 1

Many patients planning to have Asian blepharoplasty (double eyelid surgery) often ask if it is necessary for them to also have simultaneous epicanthal fold operation (aka epicanthoplasty, 開眼角). The answer depend very much on what the patients want, if the patient just wants upper eyelid creases then double eyelid surgery is all that is needed. However, if the patients want their eyes appear longer or less squinting (as in some patients with significant epicanthal fold which will mention later) then epicanthoplasty can be performed. 

While epicanthoplasty may look good on patients, it is important to bear in mind some possible disadvantages:

a. Epicanthal fold is characteristic of East Asian eyes, excessive removal may alter the ethnic appearance of the patients;

b. While epicanthoplasty may make the eyes longer, the two eyes will also appear closer together;

c. The area around the epicanthal fold is thicker and more easily scar, so it is important to find an experienced surgeon. 

Before discussing different methods of epicanthoplasty, it is worth taking a look at epicanthal fold. The epicanthal fold is made up of a fold of skin that extends from the upper eyelid across the medial part of the eye to the margin of the lower eyelid. This structure is seen in foetuses of all races before birth, however, except in the East Asians it usually disappears before birth. This structure is seen in over 90% of East Asians origin but only in 2% of Caucasians. 

The epicanthal fold covers the lacrimal caruncle (the red fleshy part of the medial part of the eye) and therefore cover part of the eye. This is one of the reasons why East Asians appear shorter than other races.

The black arrow in the upper picture denotes the epicanthal fold which covers 

some of the lacrimal caruncle (LC) as compared with a Caucasian eye 

which has no epicanthal fold and the lacrimal caruncle (LC) is fully exposed.

The effect of removing or modifying the epicanthal fold on the length of the eye is best demonstrated in the pictures below:

The picture above shows a patient with epicanthal fold and the length of the eye 

is denoted as a. However, when the epicanthal fold is removed (in this case 

by moving the fold digitally) the length of the eye is increased (a +b) through

 exposure of the inner corner of the eye and the lacrimal tubercle (b). 

The effect on the length of the eye depends on the extent of the epicanthal fold.