Eliminating or decreasing the epicanthal fold is challenging because of its location in the highly visible and easily distorted tissues between the nose and eye and because it overlies the delicate tear drainage canals.
A number of improved modern surgical approaches have been described. All employ the use of multiple tiny skin flaps, which may result in prolonged healing time and overactive and noticeable scarring.
Unless the epicanthal fold is unusually prominent or cosmetically bothersome, we generally recommend against surgical manipulation of this delicate skin.
In a small minority of our patients who are bothered by the narrowing effect of the fold on the horizontal dimension of the eyelids, we prefer a technique known as "root Z-epicanthoplasty."
