Small eyes, epicanthal folds

What is an Epicanthic Fold?

At the inner corner of the eye, there is a skin fold running from the upper eyelid downward, covering the pink tissue (lacrimal caruncle). When prominent, this fold obscures the inner aspect of the palpebral fissure, making the eyes appear shorter, rounder, and wider apart. It can also pull the double eyelid crease (if present) inward, creating a "tapered" or hidden inner fold. The severity of an epicanthic fold is classified by the degree of caruncular coverage: mild, partial, or near-complete.

What Causes Small Eyes — Epicanthic Folds or Eyelid Hooding?

These two causes often coexist. Upper eyelid hooding makes the eyes look smaller vertically — addressed with double eyelid surgery (blepharoplasty) or crease creation. Epicanthic folds shorten the eyes horizontally — addressed with medial epicanthoplasty. The surgeon measures the palpebral fissure length and the intercanthal distance: if the intercanthal distance is significantly wider than the fissure length, epicanthoplasty is beneficial; if they are nearly equal, opening the inner corners may bring the eyes too close together, resulting in 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 using small skin flaps (commonly a Z-plasty or its variants) to expose more of the lacrimal caruncle and elongate the palpebral fissure by a few millimeters. Limitations: the procedure is limited by the patient's anatomical structure — overcorrection exposes too much of the pink caruncle, appearing unnatural; scars at the inner canthus may take longer to fade than eyelid scars; and it cannot truly move the eyes closer together since the underlying bony orbit remains unchanged.

What Determines the Degree of Improvement?

The severity of the epicanthic fold, intercanthal distance, the presence of hidden folds or ptosis, skin thickness at the inner canthus (thicker skin takes longer for scars to soften), and bilateral symmetry. In many cases, simply creating the appropriate eyelid crease shape can visually elongate the eyes without the need for epicanthoplasty.

How Does BonBoz Approach Small Eyes and Epicanthic Folds?

A plastic surgeon measures the palpebral fissure length, intercanthal distance, and the degree of caruncular coverage using standardized clinical photography, while evaluating the upper eyelids and levator muscle function. Based on this, a tailored plan is recommended: eyelid crease creation alone, crease creation combined with medial epicanthoplasty, or standalone epicanthoplasty if the existing crease is already well-defined. The examining doctor is the one who performs the procedure; incision placement, expected scar maturation timeline, and estimated elongation are clearly communicated beforehand.