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."

The operation is shown here step-by-step (Caution: Actual surgery photos). Even though final scarring with root Z-epicanthoplasty is acceptable in most patients, the absence of an epicanthal fold on the Asian face may appear unnatural. When scarring from epicanthoplasty is objectionable and deep, corrective surgery is difficult and generally only partially successful.

Depressed Scar After Surgery Performed Elsewhere

A so-called "no-scar epicanthoplasty" procedure has also been described and involves removal of eyelid muscle underlying the skin of the fold during double eyelid surgery without requiring extra skin incisions. While this procedure may soften the fold very slightly, there is no horizontal elongation and so its effect is subtle at very best.