What is an Epicanthic Fold?
At the inner corner of the eye, there is a skin fold running from the upper eyelid downward that covers the pink area (lacrimal caruncle). When this fold is prominent, it conceals the inner part of the palpebral fissure, making the eyes appear shorter, rounder, and farther apart. Any existing double eyelid crease may also be pulled by the epicanthic fold into a "tapered/hidden inner crease." The severity of the epicanthic fold is classified by the extent of the lacrimal caruncle covered: minimal, partial, or near-complete coverage.
What Causes Small Eyes — Epicanthic Folds or Eyelid Hooding?
These two causes often coexist. Upper eyelid hooding makes the eyes appear vertically smaller—addressed by double eyelid creation or blepharoplasty. An epicanthic fold makes the eyes appear horizontally shorter—addressed by medial epicanthoplasty. The surgeon measures the palpebral fissure length and the intercanthal distance: if this distance is significantly greater than the length of one eye fissure, epicanthoplasty is indicated; if they are nearly equal, epicanthoplasty may make the eyes look too close together and create a harsh appearance.
What Does Medial Epicanthoplasty Do and What Are Its Limitations?
This is a minor surgical procedure that rearranges the skin folds at the inner corner of the eye using small skin flaps (typically a Z-plasty or its variants) to expose more of the lacrimal caruncle and elongate the palpebral fissure by a few millimeters. Limitations: the opening is strictly limited by the patient's anatomical structure—over-resection exposes excessive pink tissue, resulting in an unnatural look; inner corner scars may take longer to fade than eyelid crease scars; and it cannot truly "bring the eyes closer together" because the bony orbital framework remains unchanged.
What Determines the Degree of Improvement?
The degree of epicanthal fold coverage, intercanthal distance, the presence of hidden creases or ptosis, the skin thickness at the inner corner (thicker skin takes longer for scars to fade), and facial symmetry. In many cases, simply creating the correct double eyelid shape makes the eyes appear longer without requiring epicanthoplasty.
How Does BonBoz Approach Small Eyes and Epicanthic Folds?
A plastic surgeon measures the palpebral fissure length, intercanthal distance, and lacrimal caruncle coverage using standardized photography; the upper eyelid and levator muscle function are also thoroughly evaluated. Based on these findings, the surgeon will recommend: double eyelid creation alone, double eyelid creation combined with medial epicanthoplasty, or standalone medial epicanthoplasty if the eyelid crease is already well-defined. The examining doctor is the one who performs the surgery; incision placement, expected scar healing time, and the anticipated degree of elongation are clearly explained beforehand.
