Medial epicanthoplasty corrects the presence of an epicanthal fold (Mongolian fold), allowing the inner corner of the eye to open up, lengthening the palpebral fissure and making the eyes appear larger and brighter. This procedure is commonly performed together with double-eyelid surgery to enhance eyelid definition and improve overall eye aesthetics.
At the junction of the upper and lower eyelids, the outer corner is called the lateral canthus, while the inner corner is the medial canthus. An epicanthal fold refers to the excess skin covering the inner corner of the eye (commonly known as the Mongolian fold), a feature frequently seen among Asian populations. When the fold is too prominent, it can affect the natural shape of the eyes, make the eyes appear smaller, cause an incomplete double-eyelid crease, or produce an overly rounded appearance. In more severe cases, it may even give the illusion of crossed eyes and can also be associated with inner-corner trichiasis.
The purpose of medial epicanthoplasty is to reduce this excess fold, open up the hidden sclera near the inner corner, and visually elongate the eye. When combined with double-eyelid surgery, it can further enhance eye enlargement.
However, if the inner corner is opened too aggressively—or if the patient originally has only a subtle epicanthal fold—overexposure of the caruncle (the pinkish tissue between the sclera and the inner canthus) may occur. This can change the overall expression of the eyes, and in patients with limited lateral sclera, excessive medial exposure may create the appearance of pseudo-exotropia (commonly referred to as "windowing"), which is aesthetically undesirable. In addition, excessive opening may increase the risk of dry-eye symptoms.
Therefore, preoperative simulation and thorough discussion with the patient are essential to determine the ideal degree of correction—preventing an unnatural gaze, overly narrow intercanthal distance, or the need for secondary medial canthus reconstruction in the future.
The most common concern among patients considering medial epicanthoplasty is the potential for scarring. There are various surgical techniques, and each method creates scars that differ in shape and placement.
"Scarless" does not mean that no incision is made; rather, it refers to techniques that strategically place and refine the incision so that the scar is hidden along the natural contours of the inner eye and does not appear on the visible eyelid skin. With proper design and healing, the scar typically becomes barely noticeable within three to six months.
This method involves excising a portion of the skin at the inner canthus and advancing the tissue to create a new medial canthal shape, resulting in a natural, refined appearance.
This technique uses a Z-shaped incision to reshape the medial canthus, redistribute tension, and reduce scar contracture. It is particularly suitable for individuals with higher skin tension in the inner canthal area.
Directly excises and sutures the excess skin at the inner corner of the eye; suitable for patients with mild epicanthal folds.
One week before surgery:
・Discontinue anticoagulants (e.g., aspirin) after confirming with your prescribing physician.
・Stop all dietary supplements such as fish oil, ginkgo, ginseng, and vitamin E.
・Avoid smoking and alcohol from one week before surgery until one month after surgery.
On the day of surgery:
・Arrive with no makeup and ensure eyelashes are clean and free of extensions.
・Do not wear any accessories or metal items; remove piercings in advance.
・If you wear contact lenses, you may arrive wearing them, but they must be removed before surgery. Please bring a storage case, glasses, or sunglasses for after the procedure.
You may choose between local anesthesia or sedation (general anesthesia).
・Local anesthesia does not require fasting; you may eat as usual.
・Sedation (general anesthesia) requires fasting for approximately 8 hours; please avoid all food and drink, including water and chewing gum.
・Please do not drive or ride a motorcycle yourself after the procedure.
・Cold and warm compresses: Apply cold compresses during the first 72 hours to help reduce swelling and bruising. After 72 hours, warm compresses may be used to promote circulation and healing.
・Wound care & dressing changes: Keep the incision area dry and change dressings as instructed. If skin sutures are present, they are typically removed around day 6–10 depending on wound healing.
・How to change dressings: Clean the wound twice daily using sterile cotton swabs dipped in normal saline, pat dry, then apply ointment. When applying cold or warm compresses, place gauze over the area to reduce the risk of infection.
・Medication & eyelid hygiene: Use prescribed eye drops or ointment as directed to prevent infection and support proper healing.
・Eye use & daily habits: Avoid prolonged screen time or extended periods of looking downward. Allow your eyes adequate rest during the recovery process.
・Diet & medications:
- Pain medication prescribed by your surgeon may be taken as needed.
- Avoid irritants such as smoking, alcohol, tea, coffee, spicy foods, and all dietary supplements (e.g., Vitamin E, lingzhi, and herbal remedies).
- Maintain a light diet, stay well hydrated, and increase intake of high-protein foods and Vitamin C to support wound repair.
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