Epicanthal fold

It is often said that the eyes are the windows to the soul. What would an unaesthetic periorbital appearance imply? It is no wonder that aesthetic improvement of the periorbital region is one of the commonest aesthetic requests. Oriental eyelids may sometimes have features that are regarded as unaesthetic. These include a lack of an upper eyelid crease, the presence of an epicanthal fold on the inner eyelid, and upper eyelid droopiness.

A youthful and aesthetically pleasing upper eyelid region consists of well-positioned eyebrows, appropriate eyebrow-to-upper eyelid crease distances, well-formed upper eyelid creases, an appropriate degree of vertical eye opening, and the absence of the epicanthal fold. These findings impart the image of an individual who is bright, attentive and confident.

How Does It Manifest?

The epicanthal fold is an additional semilunar skin fold that descends along the inner (medial) upper eyelid to the medial aspect of the lower eyelid. These folds cause apparent widening of the distance between eyes. The epicanthal folds also partially obscure the inner white portion (sclera) of the eye causing it to appear unnaturally small and round instead of the usual almond shape. There are four variants of the epicanthal fold, of which the epicanthus palpebralis and epicanthus tarsalis are the most common in Oriental individuals.


How does it arise?

There are several theories regarding the cause of the epicanthal fold. It has been variably attributed to abnormally thickened or kinked (orbicularis oculi) muscle and abnormal fibrous attachments between the muscle and the overlying skin.


How are men and women different?

Females generally have thinner upper eyelid skin and a crease height measuring 5 to 6 mm from the eyelid margin. They tend to favor higher folds, revealing about 1 to 2 mm of upper eyelid skin above the eyelashes that permit the application of makeup.

 In contrast, males tend to have thicker upper eyelid skin and often prefer deeper-looking creases. Their crease height may range from 5 to 7 mm from the eyelid margin, and they often favor a fold that completely covers the upper eyelid skin without revealing the skin above the eyelashes. This is also known as a “buried” fold.

treatment - Epicanthoplasty

Epicanthal folds are only effectively treated by surgery. It is often performed as an adjunct to upper blepharoplasty or double eyelid crease creation and when combined, brings about significant improvement to the aesthetic of the eyelid region. We use proprietary epicanthoplasty techniques that will deliver exquisite and bespoke results. Epicanthoplasty is an ambulatory procedure performed under local anesthesia. Successful outcomes improve self-esteem and social functioning.


Epicanthoplasty restores the natural almond shape of the eye, removes the abnormal skin fold covering the inner (medial) sclera and partially unveils the inner pink portion of the eye (lacrimal lake). A well-executed epicanthoplasty narrows the apparent width between the eyes, while keeping scarring to a minimum.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

Epicanthoplasty is a fine art that strikes a balance between inner eye opening while minimizing postoperative scarring. The operative plan is tailored to the individual pathology. Local anaesthesia is infused to the operative site for optimal intra- and post-operative analgesia.

The skin is incised and released from the underlying orbicularis oculi muscle. The muscle itself may be excised or rearranged, followed by excision or repositioning of the overlying skin. The wound is then closed meticulously to deliver the optimal postoperative scar and aesthetic outcome.

Mild swelling is expected after the surgery, and most of it will resolve by the 5th postoperative day. The stitches are removed on the 5th postoperative day and most individuals are able to return to work after the stitch removal.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. An optional electromagnetic field device may be used for the first 5 days to accelerate wound healing and reduce swelling.

Strenuous activity should be avoided for the first two weeks to minimize bruising. their usual activities immediately following the procedure.