Epicanthoplasty is a cosmetic surgery that removes or reshapes the epicanthal fold, a curved flap of skin that covers the inner corner of the eye. By opening up this area, the procedure makes the eyes appear wider and more horizontally elongated, while revealing the small pink tissue (called the caruncle) that sits in the inner corner. It is one of the most popular cosmetic procedures among Asian patients and is frequently performed alongside double eyelid surgery.
What the Epicanthal Fold Actually Is
The epicanthal fold is a vertical or diagonal arc of skin that drapes over the inner corner of the eye, partially hiding it. Underneath the surface skin, there’s a core of muscle fibers and a fibrous band that anchor the fold in place and create the characteristic webbed appearance. This combination of extra skin and underlying tissue is what makes the fold persist and why simply trimming skin away won’t produce a lasting result.
Epicanthal folds are extremely common in people of East Asian descent, but they also appear in other populations and in certain genetic conditions. Not everyone with an epicanthal fold wants it altered. The procedure is elective and driven by personal aesthetic preference.
Types of Epicanthal Folds
Surgeons recognize four varieties, classified by where the fold sits most prominently:
- Tarsalis: the fold is most noticeable along the upper eyelid. This is the most common type in East Asian eyes.
- Inversus: the fold is most prominent along the lower eyelid.
- Palpebralis: the fold involves both upper and lower eyelids equally.
- Superciliaris: the fold starts near the brow and extends downward toward the tear duct area.
The type of fold influences which surgical technique a surgeon chooses and how much tissue needs to be rearranged.
How the Surgery Works
The core goal of any epicanthoplasty technique is to release the tension that holds the fold in place, both vertically and horizontally. Rather than just cutting away skin, the surgeon rearranges the tissue so it lies flat and the inner corner of the eye is exposed. Several techniques exist, each with a different approach to achieving this.
In a Z-plasty, the surgeon makes Z-shaped incisions that allow two small triangular flaps of skin to swap positions. This redistributes the tension and breaks up the fold without removing much tissue. Refinements to this method focus on making the incisions discontinuous (not in one continuous line) to prevent the scar from contracting into a visible line as it heals.
The skin-redraping method takes a different approach. Instead of swapping flaps, the surgeon lifts the skin, addresses the fibrous band and muscle tissue underneath, then redrapes the skin smoothly over the area. This targets the structural cause of the fold rather than just the surface skin.
No single technique dominates. Each has trade-offs in scar visibility, ease of execution, and how natural the result looks. The lack of a single standardized protocol means outcomes can vary between surgeons, making the surgeon’s experience with the specific technique an important factor.
Combining With Double Eyelid Surgery
Epicanthoplasty is very commonly performed at the same time as double eyelid surgery (blepharoplasty), which creates or enhances the crease in the upper eyelid. There’s a practical reason for combining them: the epicanthal fold can make a newly created eyelid crease look pinched or tapered near the inner corner instead of running smoothly across the lid. Removing the fold allows the crease to extend more naturally toward the nose, producing a more parallel, open look.
When the two procedures are combined, surgeons typically create the eyelid crease first. This sequence matters because forming the crease changes the tension on the surrounding skin. If the epicanthoplasty incisions were made first, the subsequent crease creation could pull on them unpredictably and compromise healing. Two-year follow-up data from combined procedures show natural-appearing creases with scars that are inconspicuous on close inspection.
Recovery Timeline
Stitches are typically removed 5 to 10 days after surgery. Swelling and bruising around the eyes generally last 1 to 3 weeks, with the most noticeable puffiness in the first few days. The overall appearance continues to improve for 1 to 3 months as residual swelling resolves and the tissues settle into their new position.
Scars at the inner corner of the eye take longer to mature than the swelling takes to fade. In the early weeks, the scar may look pink or slightly raised. Over several months it typically flattens and lightens, though the inner corner of the eye is a spot where scarring can be more visible than on the eyelid itself because the skin is thinner and doesn’t have a natural crease to hide in.
Scarring and How to Minimize It
Visible scarring at the inner corner of the eye is the most discussed concern with epicanthoplasty. Across eyelid procedures in general, the rate of hypertrophic (raised, thickened) scarring is roughly 1%, based on a systematic review of over 3,600 patients. Keloid scarring from purely cosmetic eyelid procedures has not been reported in published studies. So while the risk is low, scars in this area can still be noticeable even when they heal normally because the skin is so delicate.
Post-operative scar management makes a measurable difference. The standard approach involves daily use of silicone sheets (worn about 12 hours a day) and silicone gel applied twice daily, continued for around 5 months after the initial scab falls off. Research has shown that adding a non-ablative fractional laser treatment to the inner corner area about 3 weeks after surgery, combined with the silicone regimen, produces noticeably better scar outcomes than silicone products alone. If scarring is a particular concern for you, asking your surgeon about early laser treatment is worth the conversation.
What Makes a Good Candidate
The procedure is designed for anyone who has a prominent epicanthal fold and wants more of the inner eye corner visible. Surgeons evaluate this by looking at the distance between the inner corners of both eyes and how much of the pink tissue in the corner is hidden. A wider-than-average distance between the inner corners, combined with a fold that significantly obscures the corner, suggests more room for improvement.
Results are considered successful when the distance between the inner corners is reduced, the visible eye opening increases, the fold is fully resolved, and scars remain well hidden. People with a tendency toward keloid scarring on other parts of the body, or those with unrealistic expectations about how dramatically the procedure will change their appearance, may not be ideal candidates.