Inner Corner Eye Enhancement

Inner corner eye opening is a minor surgical procedure that adjusts the skin fold covering the inner corner of the eye (medial canthal fold) using small Z-shaped or variant skin flaps, exposing more of the pink area at the inner corner and increasing the visible eyelid space by approximately 2–4 mm on each side. It is indicated when the medial canthal fold covers a significant area and the distance between the two eyes is wide; it should not be performed when the eyes are already close together.

Medically reviewed by BS.Ths.CKII Nguyễn Xuân Vũ — BonBoz Clinic

Mechanism

The fan fold is a skin fold that stretches from the upper eyelid down to cover the lacrimal gland at the inner corner, shortening the appearance of the eyelid slit. The technique for opening the inner corner of the eye creates small skin flaps in a Z shape (Z-plasty) or its variations (Park, Hiraga, etc.) to change the direction of skin tension, rotating the flap so that the fold no longer covers the lacrimal gland and the eyelid margin extends inward. Minimal skin is removed; the main focus is on rearranging, so the outcome depends on the flap design and the level of skin tension.

Limitations to Know

Opening the inner corner of the eye can only extend to the extent of the lacrimal gland and the structural allowance—typically 2–4 mm on each side. It is not possible to truly "bring the eyes closer together" because the orbital bones do not change; if the distance between the inner corners is already short (equal to or less than the length of an eyelid slit), opening the corner will make the eyes appear too close and harsh. Excessive opening may expose too much of the pink lacrimal gland, resulting in an unnatural appearance and making it nearly impossible to close.

Indications

The fan fold covers part to nearly all of the lacrimal gland; the distance between the inner corners is wider than the length of the eyelid slit; the fan fold pulls the double eyelid fold into a hidden fold at the outer corner. It is often performed alongside eyelid surgery to synchronize the opening of the outer corner.

Risks to Be Aware Of

Scarring at the inner corner of the eye may take longer to heal than eyelid scars (3–6 months, possibly longer for thicker skin), scar contracture creating new folds, excessive exposure of the lacrimal gland, asymmetry between sides, temporary tearing due to swelling, and rare cases of damage to the tear duct. Therefore, the surgeon will open just enough and simulate the outcome beforehand.

At BonBoz

The plastic surgeon measures the length of the eyelid slit, the distance between the inner corners, and the extent of lacrimal gland coverage on standardized photos; they will only recommend opening the corner if the proportions allow and will be straightforward if it should not be done. The flap technique is chosen based on the direction of skin tension for each individual; the examining doctor is also the one performing the surgery, providing guidance on caring for the inner corner scars (sun protection, scar gel) and follow-up visits up to six months.

How is it performed?

Local anesthesia. The doctor marks the design of the flap (Z or variant) at the inner corner of the eye following the direction of the fan-shaped crease, incises along the marked line, separates and rotates the skin flaps to change the direction of tension, exposes the lacrimal gland, and extends the eyelid margin inward to the measured extent, suturing with very fine thread. The procedure takes 30–60 minutes for both sides and is usually performed in conjunction with double eyelid surgery.

Before the procedure

Measure the palpebral fissure, the distance between the inner canthi, and the level of tear duct coverage; take standardized photos; simulate the expected opening level; discontinue anticoagulants, alcohol, and smoking as instructed.

After the procedure

Apply cold compress for 48 hours, keep the area clean, and take prescribed medication; remove stitches on days 5–7; pink scars will last 1–3 months, gradually fading by month 6; use sunscreen and scar gel as directed; follow-up appointments on days 7, months 1, 3, and 6.

Possible risks — your doctor explains them before treatment

Scars at the outer corner of the eyes tend to last longer than eyelid scars, typically ranging from 3 to 6 months. Contracture scars can lead to the formation of new folds in the skin. There may also be excessive exposure of the tear duct, which can result in asymmetry between the two sides of the face. Additionally, patients might experience temporary tearing as a side effect. In rare cases, there can be an injury to the lacrimal duct.

Who should NOT have this?

The inner corners of the eyes are closely set.
The eyelid fold is minimal, and the small appearance of the eyes is primarily due to eyelid coverage (only requiring the creation of an eyelid fold).
There is a tendency for hypertrophic scars and keloids.
Currently experiencing inflammation in the eye area, with nasolacrimal duct inflammation.
Aiming to elongate the eyes by several millimeters or alter the bone structure.

BS.Ths.CKII Nguyễn Xuân Vũ

Department of Plastic and Aesthetic Surgery

Master of Medicine and Pharmacy — Specialist Level I Surgical Resident, Hue University of Medicine and Pharmacy (2014–2017)
Specialist Level II Doctor in Plastic and Aesthetic Surgery
Specialist Level I in Plastic and Aesthetic Surgery — Pham Ngoc Thach University of Medicine; Specialist Level II in Healthcare Management — University of Public Health
Specialty Certificate in Orthopedics and Traumatology and Certificate in Plastic and Aesthetic Surgery (2017)
Medical Practice License No.: 007827/ĐL-CCHN — Issued by Dak Lak Province Department of Health on 04/12/2017
Over 15 years of experience, more than 20,000 surgeries
Specialist Level II Doctor in Plastic and Aesthetic Surgery at Ho Chi Minh City Hospital of Dermatology (2020–present); previously Lead surgeon for major and minor procedures at Sao Han Hospital (2018–2020)
Member of international humanitarian organizations Operation Smile and ReSurge International — performing pro bono reconstructive surgeries for patients with congenital deformities, cleft lip, cleft palate, and ptosis (2022–present)
Affiliated with Alcon Pharmaceutical (USA)
Member of the Korean College of Cosmetic Surgery (KCCS)
Medical Director of BonBoz Clinic

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Frequently asked questions

How much can the inner corner of the eye be elongated?

Typically 2–4 mm on each side, depending on the coverage of the fan fold; exceeding the allowable structural limit will expose too much of the tear gland.

Is the scar at the inner corner of the eye noticeable?

The skin at the inner corner of the eye is thicker than the eyelid, so the scar typically fades within 3–6 months; the incision line is placed along the natural fold and requires sun protection and scar gel.

Can it be done together with eyelid surgery?

Usually yes, to synchronize the eyelid fold and the inner corner opening; it can also be done separately when the eyelid fold is stable.

Can the inner corner of the eye be 'closed' again?

It is very difficult and not completely possible because the skin has been rearranged. This is why the doctor opens just enough and simulates beforehand.

Does it affect the tear duct?

The technique only intervenes in the skin and superficial tissue; if done correctly, it does not touch the tear duct. It is normal to have tears for a few weeks due to swelling.

How long is the recovery?

Swelling lasts 5–7 days, stitches are removed on days 5–7, the scar lasts 1–3 months, and the shape of the eye stabilizes within 3–6 months.

Should I undergo the procedure if my eyes are close together?

It is not advisable; opening the corner when the distance between the inner corners is short will make the eyes appear closer together and look fierce. The doctor will measure beforehand to decide.

Is it possible to elongate the outer corner of the eye as well?

Only if the outer tail of the eye is short or has a defect; the outer corner can be elongated less and needs to be evaluated separately.