In the current era, you can change anything in your appearance, whether it is functional or aesthetic. For example, rhinoplasty, also known as nose job operations, have now become very popular and very easy. The patient can leave the hospital on the same day of the operation. 

Likewise, you can apply this example to many changes we can make to improve the way we look.

Our video today is about a type of plastic surgery that has become very famous. 

Although it might seem a very simple surgery, it can totally change the look of your eyes. 

Epicanthoplasty Surgery

So, for those who have never heard about it, what is epicanthoplasty? 

Epicanthoplasty is an eye surgery that modifies the epicanthal folds or the Mongolian folds. It is medically known as medial or lateral epicanthoplasty and it aims to lengthen the inner part of the eye to make the eyes look bigger. 

Epicanthal Fold

A strong epicanthal fold (also known as the "Mongolian fold") means that a web forms over your eye and covers your medial canthus. This fold can hide the attractiveness of your eyelids and make your eyes appear smaller and weary. This operation is typically performed on people of Asian heritage, although it is available to any man or woman who desires brighter, larger, and more alert eyes.

The surgery is also known as “Inner corner fold removal” or “Mongolian fold correction”. It is a cosmetic procedure mostly performed in Asian countries. The Mongolian fold is one of the most prominent features in Asian countries.

The skin protecting the inner corner of the eyes has certain drawbacks:

1. The space between the eyes looks to be large. It makes the eyes feel uncomfortable.
2. Eyes can appear smaller
3. The shape of the eyes looks undefined

Epicanthic fold European

A Mongolian fold, which covers the medial part of the eyes and makes them look smaller than the rest of the facial features, is present in about three out of every five Asians. In the event of a Mongolian fold, a candidate's result may be less successful or less natural-looking if simply double eyelid surgery is performed without epicanthoplasty.

When combined with epicanthoplasty, eyelid surgery can result in a more equal length between the eyes as well as a more delicate and defined eye look. In the case of Asian patients, the surgeon must be cautious not to remove the complete epicanthal fold. The patient may lose their original Asian identity in such a case.

In Asians with a harsher look, much of the epicanthal fold may be eliminated, leaving only a little portion. This will result in a softer, more open appearance. Patients with existing round facial features, on the other hand, should have a little epicanthal fold following surgery to contrast sharper eyes with other softer aspects of the face.

Epicanthoplasty is a procedure that includes making extremely small incisions on the inner corners of the eyes to address the issues listed above. Bigger, cleaner eyes are the result. Epicanthoplasty is frequently combined with Double Eyelid Surgery to create significantly cleaner, more attractive, and natural-looking eyes.

The Mongolian fold is the skin of the upper eyelids which covers the inner corners of the eyes. People usually go for epicanthoplasty due to the downfalls of the skin covering the inner corners of the eyes, such as: 

• It causes an awkwardness to the eyes because it makes the distance between both eyes look too far. 
• Eyes appear smaller than they are. 
• The folds give the eyes an undefined look. 

Simply put, this skinfold can impair the beauty of the eyelid and gives the eye a smaller lateral appearance and a more tired-looking appearance. 

Although the epicanthic fold or Mongolian fold can be associated with less prominent upper eyelid creases, or what is called “Single eyelids”, they both are distinct. A person can have both an upper eyelid crease and an epicanthal fold, one of them only, or neither of them.

Epicanthoplasty is not only an aesthetic surgery, it is sought by men and women who have abnormally large folds that impact not only the appearance but also t eye physiology, making them look bigger. 

What Are The Benefits of Eye Enlargement Surgery?

So, what are the advantages of this procedure? Epicanthoplasty can be used to:

• Reduce the space between your inner-canthal, which makes your eyes seem to be farther apart (an ideal distance between the inner-canthal is a 1:1 ratio)
• Make your eyes look brighter and larger by exposing the medial part of your eyes.
• Minimize the medial part of your eye folds to reduce wrinkles in your eyes and seem less fatigued.
• Shift the medial canthus in a medial and upward manner to make your eyes look less slanted.
• Epicanthoplasty can also assist to improve your face's overall appearance by alleviating tiredness.

The question is, is anyone eligible for an epicanthoplasty? In other words, who should undergo epicanthoplasty? 

Epicanthoplasty is originally a cosmetic procedure. However, it can be sought by anyone who wishes to have wider eyes than their physiology allows. 

It is the ideal surgery for males or females patients who: 

• Have relatively good health. 
• Have eyes that are abnormally far from each other leading to disproportionate appearance.
• Wish to improve their overall appearance, maintaining their ethnic features. 
• Have undergone or are going to undergo double eyelid surgery to further improve their look and have a much clearer and more beautiful look. 
• Have a very short horizontal length of the eyes. 
• Want a mild or soft shape of the eyes. 
• Want a larger appearance of the eyes. 
• Have undefined eyes which appear very close together due to Mongolian folds. 

You will need to be in good general health to be a suitable candidate for epicanthoplasty. If you smoke, you must stop three weeks before and three weeks after surgery. This is because smoking might impair your body's capacity to completely recover.

Epicanthoplasty is mostly sought by people who want to adopt a brighter, bigger, and more alert look of their eyes. 

But, unless the epicanthal folds are cosmetically bothersome and abnormally large, it is not advised to undergo any surgical manipulation in this delicate area. 

But as we know, every surgery has its complications and risks. So is the case with epicanthoplasty. Beauty is pain, isn’t it? 

Medial Epicanthoplasty

The corner of the eye near the nose is the focus of this treatment. A Medial Epicanthoplasty shapes and contours the inner corner of the eyes, making them appear longer and more almond-shaped. It is frequently used in conjunction with Asian Blepharoplasty to give the eyes a rounder, clearer look.

Lateral Epicanthoplasty

Lateral Canthoplasty is a lower eyelid surgery that targets the outside corners of the eyes. This technique enlarges the outer corners of the eyes, making them appear larger and longer. When double eyelid surgery incisions are combined with a Canthoplasty, the combination improves the contour and angle of the eyes.

How dangerous is Epicanthoplasty?

First, we need to emphasize the fact that if Epicanthoplasty is performed by a licensed well-experienced surgeon, it will be a completely safe procedure with high success and satisfaction rates. 

However, just like any procedure, some possible risks and complications might arise. As a surgical candidate, you should consider and be fully aware of these risks including: 

• Allergies. Skin testing is always performed before the surgery to eliminate any risks; however, some people might be allergic to anesthesia and sutures.
• Poor scarring. Some people may notice a scar after the procedure for a few months, but they improve over time. However, epicanthoplasty these days is performed using certain techniques with hidden incisions to avoid visible scarring. 
• Infections. It is an extremely rare complication due to infection at the incision site, however, it can be treated easily by a topical or oral antibiotic. 
• Unsatisfactory results. That can be easily avoided by making sure that your surgeon is a very experienced professional.. 

Postoperative complications of epicanthoplasty can be very rare, however, the procedure itself might be challenging because the epicanthal folds overlie the lacrimal canaliculi, the tear drainage canals. This location is highly visible and the tissue there, between the nose and eyes, can be easily distorted. 

Any small mistake may interfere with the tear drainage system of your eyes, but this is also easily avoidable. 

Can the surgery be reversed? 

In fact, yes, it can be reversed. If the patient is not satisfied with the results, the surgeon can recreate the Mongolian fold by pulling the soft tissue on the scars and thus restore the previous shape of the eye. 

Some of the operative details. 

Before the surgery, your surgeon will show you how your eyes will look and how your appearance will be using a personalized virtual design. 

The operation itself won’t take long. It usually takes a minimum of 30 minutes and a maximum of fewer than 60 minutes.  Sometimes it is done with only local anesthesia. After the surgery, there will be remaining stitches, they will be removed after five or nine days.

You will have to follow up with your surgeon twice per week to make sure everything is fine and to remove your stitches when it is time. Some people might be scared of scars, but scars can be minimized if incisions are made only where necessary. After all, even slight scars will fade away over 6 months. 

Healing time for Bepharoplasty

As for recovery time, it differs from one person to another according to the quality of their wound healing. But most people return to work within a week or less. 

But what about positioning epicanthoplasty? What is it? And what is the difference in relation to  usual epicanthoplasty? 

If the eyes are close together, usual epicanthoplasty will make eyes much closer together which, in the end, gives unsatisfactory results. 

However, when incisions are minimized and the epicanthal fold is removed, this is called positioning epicanthoplasty. 

Now you must be wondering, how is the procedure done? 

Once you have decided to undergo an epicanthoplasty, a pre-surgical evaluation is done first to assess the severity of the epicanthal fold. 

When the assessment is done, your surgeon will know exactly the type of surgery you need and the location where the incisions will be done. 

There are two different types of epicanthoplasty. Medial epicanthoplasty and lateral epicanthoplasty. 

Medial epicanthoplasty focuses more on the inner corner of the eyes. It makes the eyes look bigger and more open. It can also straighten out the slanted eyes. 

Previous methods of medial epicanthoplasty left scars but now there are new techniques with minimal scarring, for instance, “The skin redraping” method.

The skin redraping method is very simple to design and easy to perform. It does not create tension or visible scars on the medial canthal region.

As for lateral epicanthoplasty, it doesn’t only focus on the inner corner of the eyes but also adjusts the outer corner of the eyes. It reshapes the lateral epicanthus by removing the skin covering the lateral canthus. 

It is very beneficial for upward sloped eyes as it can correct them. It can also significantly lengthen the eyes. It achieves overall harmony of the look of the eyes. 

After deciding which type of surgery suits you, your surgeon will set an appointment for your surgery date. 

The actual surgery starts by applying local anesthesia. 

Once the anesthesia starts working, your surgeon will make the pre-planned incisions around either the medial or lateral corner of the eye. The surgeon will create skin flaps to reshape the structure of the inner eyelid and excess skin will be removed. 

In lateral Epicanthoplasty, when the incision is done on the outer corner of the eye, the eyes will open up and the surgeon will suture the open skin folds. 

After the surgery, the eyelids might appear swollen and bruised but they will return to normal and heal over the recovery period. 

How effective is Epicanthoplasty surgery on larger eyes?

Each patient has unique eye anatomy, Mongolian fold, and eye shape. These distinctions influence the technique of Epicanthoplasty on a case-by-case basis. As a result, the best tailored surgical strategy will be determined during consultation. Our clinic makes every effort to get the best possible results for each patient.

How much Blepharoplasty?

The price of Epicanthoplasty surgery varies depending on the specific treatment plan. Epicanthoplasty is often paired with other procedures so the cost is often bundled together with Double Eyelid Surgery or Aging Upper Blepharoplasty. An individualized surgical plan will include a pricing breakdown.

Epicanthoplasty in Korea

Epicanthoplasty is a common procedure for patients who want larger eyes. This surgery can also get rid of the Mongolian fold, which is common among Koreans and Asians. Because the inner eyelid is one of the most sensitive areas of your eyes, Epicanthoplasty should be performed with extreme caution. Epicanthoplasty is frequently performed in combination with double eyelid surgery in South Korea to produce a more natural appearance.

To ensure that you get a comprehensive picture and understand everything regarding Epicanthoplasty, we invited Dr. Jae-Woo Park who is a renowned cosmetics surgeon from Seoul, Korea to address any questions you may have from an experienced point of view.

Interview

1. Are there any changes between the previous and current epicanthoplasty techniques?

Epicanthoplasty? Epicanthoplasty deals with the internal eye area surgery. Since many Asians tend to have a less open eye area, many pursue this procedure. Long ago, there were many techniques. But the majority of the techniques were based on repositioning tissue underneath the eyelid, but there were many issues with scarring after surgery. So many patients disliked the outcome due to scarring. Thus, many desired improvements upon this procedure in order to avoid scarring. Therefore, now we utilize a technique called redraping in order to minimize the potential for visible scarring. Using the redraping technique, we make sure the scars do not show up outside.

2. Which type of epicanthoplasty do you mainly do in Korea?

In Korean, the norm is to use the skin redraping technique, which limits visible scarring by relaxing the muscle tissue in the epicanthal layer.

3. Can you briefly explain the difference between the techniques you have mentioned?

Yes, the fundamental issue is whether the epicanthal layer of the eyelid is open or closed. In general, Asians have it closed due to the presence of muscle tissue. Therefore, the aim is to relax the muscle in the epicanthal layer. However, in the past, the problem was…the aim in the past was to alter the skin (how to extend or cut) but today the technique is to relax the muscles beneath in order to achieve the desired appearance. The problem is the muscle beneath, not the outer skin. Long ago, surgeons simply used to cut the skin so there were issues with visible scarring. Nevertheless, today, we view it as a muscle tissue issue, and the skin is something that follows naturally when the underneath muscles are rearranged.

4. How do you find the perfect eyelid shape for your client?

When patients arrive, we ask what kind of eye look they want. Among those who visit me, there are many Asians and many Russians. There are some differences between Asians and Russians. Asians like Koreans tend to have eye shapes that are slightly closed but not enough to impair vision. The white area to the left and to the right of the center are well proportioned. The white part close to the center of the face is proportioned at one and the white part to the side is proportioned 1.5x that of the white part close to the center of the face. If so, it is pretty. In addition, a mild double eyelid sized 6mm to 7mm. In addition the upper eyelid should cover the center of the eyes about 1mm to 2mm while the bottom part should barely touch it. We prefer this type of proportioned eyes. Therefore, the question is how far or close is the current eye shape, thus how we will achieve this desired eye shape is what we would discuss with the prospective patient.

5. What kind of person is not suitable for this surgery?

As discussed, Epicanthoplasty is suitable for those with a closed eye disposition in the area. However, if the patient already has an open eye area, the procedure cannot be done as there is nothing to open up. Thereforer, if the procedure is done in such cases, problems ensue. The muscles should be relaxed only as needed, because if it is done excessively, problems occur where the original state reverts. Therefore, opening up the muscle layers as needed will have good results.

6. What’s the difference between Epicanthoplasty for western and Asian clients?

Westerners already have an open eye lid, so there is no need to open further. However, there are some Westerners who have partially opened eyelids. The reasons are two. One, some are born that way, and some become like that as they age. As they age, the eyelid droops and closes a bit. In such cases, we must open up a little. Also, in pronounced double eyelids, it can impair the opening, thus in such cases we can open it up a bit more.

7. What kind of eyelid shape do Asian clients mostly request?

Mostly, they say it is difficult to open their eyes wide. But they do not know the reason why. And "my eyes look too round" and wish to extend sideways, but not too much so. These types of people tend to undergo surgery. Therefore, we can look at this case where she only had the procedure done in the front side, yet the eyes look wider now.

She does look like she has wider eyes now.

I opened only 1mm, yet the change is visible. Asians prefer elongated side openings. Among Asians, there are many who have too much tissue in the eye area with too much fat in the upper eyelids. In such cases, we need to open wide. However, every person’s situation is different, in a way. Some have drooping eyelids, which can be fixed by opening the eyes in a pronounced way. In this person, the eyes are small and roundish. It can be fixed like this picture. We can show possible pictures and arrive at a consensus with the patient for her desired look. With this person, I wish her eyelids were more opened in the rear, like this.

8. What is the epicanthal fold?

As for the epicanthal fold, in the past it was said that Mongols have it but in reality, about 70% of Asians have it. So, epicanthal folds can obstruct the frontal vision. This is due to the existence of a muscle that connects the upper and lower eyelids. Why is that? When we were in the mother’s womb, it was supposed to disappear. When we look at Westerners, they do not have it. However, Asians have it. That is why the fold exists. In surgery, we need to cut the muscle. Therefore, in epicanthal fold surgery, we cut the muscle that connects the upper and lower eyelids.

9. What is canthoplasty? Is it a method to do with Epicanthoplasty?

As I said before, the proportion between the frontal and side of the eyes need to be well balanced. In order to achieve optimum proportion, we do Epicanthoplasty or medial canthoplasty. Medial canthoplasty or Epicanthoplasty deals with surgery of the frontal area while lateral canthoplasty deals with surgery on the sides of the eyes. Therefore, the result is first, the angles change from slant to a more even look. There are many Asians who dislike their eye slant, so to achieve a more balanced look, we open up the lateral area to match the frontal area. Therefore, in order to achieve this look, we do both medial canthoplasty and lateral canthoplasty. Same with this patient, we achieve the desired well-balanced look.

10. How do you resolve the esthetic difference between yours and the clients?

Even if I suggest what could be beautiful, the patient has his/her own mind as to what he/she desires. Some want out fold, some want in fold, and some want parallel. Some want thin folds, some want medium, and some want high creases while some want tapered, and some want parallel folds (creases). This is because everyone has his/her own ideal look. Therefore, the patient’s preference is important. Nevertheless, some who look good in certain procedures and some who do not. Therefore, it is a consultative process by which we decide on what procedure to go with.

11. What would doctors do to solve unbalanced eyelids after surgery?

After surgery, many do it again for a variety of reasons. It can be due to various scars, unbalanced looks, etc. In such cases, we must do the surgery again. However, we must know exactly why the patient wants to undergo surgery again. For example, if we look at this patient, she had surgery before but her epicanthal layer is intact and the eyes are not balanced which must be adjusted thru surgery. So that the frontal area is opened but not too much. Therefore, after a month she looks like this.

It is important to know the root reasons. In her case, opening her eyes fully was compromised before. And she had a frontal fold due to excessive fat in the outer eyelid layer, which pushes her double eyelids to diminish it. Therefore, we took away her eyelid fat, then rearranged her folds, then raised her eyelid angles and we arrived at this look.

If we look at this patient, the double eyelids that were done before have all disappeared. In her case, we cut the epicanthal folds on both sides and removed the upper lid fat and we made her look like this. This has been about six months since her surgery.

She looks much more beautiful.

Therefore, in the past we simply made a double eyelid. Now we focus on how to make a double eyelid that fits her unique face.

12. What would doctors do to solve double eyelid scars that were too pronounced after surgery?

Yes, this type of scar we call “sausage”. The reason we call it a sausage is when the fold is too big or when the muscle tissue right below the fold was removed excessively. In such cases we need to remove the sausage and do surgery once more. It is important to do surgery tactfully. Moreover, if sausages appear, we can remove them and redo the surgery.

13. How often do patients come to you or come to Korea after their first unsuccessful Epicanthoplasty?

The reason is that the surgery was botched, possibly cutting less than necessary. Alternatively, it was cut excessively. If it was cut more than necessary, then it must be closed again. There are many reasons why it can be botched. If it was cut less than needed, then cut more. In addition, when opening the area, instead of the skin it should be the muscles beneath. If too much was excised, then it needs to be closed again. Therefore, depending on the patient’s problems we can act upon them. We carefully look for the errors and perform the next surgery.

14. Is it difficult to redo the work from other doctors?

For patients who come for redoing their prior surgeries, it is key to see what the problems are. For example, some cannot open their eyes, and why? Did they cut too much of the muscles needed for opening their eyes? Alternatively, did they cut too little? Did the cut-off muscles drop off? On the other hand, are they born that way? We look at the entire issue to resolve it. For example, in this case, a patient cannot fully open their eyes, which is congenital.

For such persons, if they come when they are young, we can perform the surgery and it works well. Nevertheless, if they come as an adult, we ask why the eyes are different. Did he/she already have botched surgery? Therefore, in this case, we can see that surgery may have been wrongly done in prior times. In these cases, we have to solve the issues. In this person’s case, he already had problems with fully opening his eyes but as he aged, it got worse. Therefore, these people’s issues are all different. Thus, performing surgery knowing their unique problems is the right way to do it. Since many do it for looks, we can tell whether the issues have been resolved through surgery.

15. To whom do you usually do Epicanthoplasty in a non-invasive way?

Non-invasive means not using a surgical knife. As I explained before, these are surgical procedures so we cannot perform epicanthal surgery without a knife.

16. What if the patient wants to do laser eye surgery and epicanthoplasty, which would you prefer the client do first?

Laser eye surgery is surgery to improve sight. There are many methods to do laser eye surgery, but many require six months rest afterwards. Thus. In such cases we ask the patients to do the laser eye surgery first as the recovery may be hindered if we do epicanthal surgery too soon after the laser eye surgery. In addition, double vision or blurred vision may occur, so we ask first to do the laser eye surgery prior to epicanthal surgery.

17. How are eye lifts or eyebrow lifts done?

Eye Lifts are done when eyebrows are drooping. If there is drooping, there are many lifting methods. For example, we can do an incision here and lift everything up. This is for older people with lots of wrinkles. When there is severe eyebrow drooping and lots of wrinkles, open surgery could be best. For those who do not have too many wrinkles, we can employ an endoscope and lift from within locally. But many patients dislike this surgery. The reason is that the surgery is not that minor, also after surgery the nerves feel strange. Thus, there are techniques that simply pull the eyebrows or cut the tissue right below the eyebrows. People who have drooping eyes can benefit from this procedure. Therefore, in this person we remove the outer part of the brows as that part is excessive. In addition, scarring is diminished extensively after one year. Therefore, this type of eyebrow surgery is common.

18. What are the side effects?

Regarding the side effects of canthoplasty, as I said before, it happens when it becomes too open or too closed. If it's too open, we close it. If it's too closed, we open it. If we look at this patient, we try to figure out what we should do. When we examine this person, we see this part being too low. And since this person has both sides lower than ideal, we have to raise both sides of this eye upwards. We raise both sides and remove the excess fat and cut excess skin. 

19. Therefore, we look at the picture one month later what you think?

Looks like a different person, right?We must look at all the potential problems first then think of all ways. That way, we can limit the possibilities of a bad outcome. If we look at this person, the frontal area is too low, the rear area is too low, and overall looks too rounded. So, in this case, we need to cut here, here, and here – all three areas. Therefore, if we try to solve this type of problem with just one technique such as Epicanthoplasty, there will be issues. Therefore, according to the problems we need the right solutions. That way, we limit the potential for side effects.

Conclusion

Epicanthoplasty is a popular cosmetic surgery procedure in Asia due to the common presence of muscle tissue in the epicanthal layer, also called Mongolian Fold. Up to 70% of Northeast Asians have it as well as some Westerners. Long ago, surgeons simply cut the skin so there were issues with visible scarring. But today, we view it as a muscle tissue issue, and the skin is something that follows naturally when the underneath muscles are rearranged. So, the concept is different now. In the past, the aim was to alter the skin (how to extend or cut), but today the technique is to relax the muscles beneath in order to achieve the desired appearance, minimizing scarring after the procedure.

In some cases, epicanthal eye surgery is not just for cosmetic purposes but also for practical reasons. Some have a pronounced epicanthal layer that obstructs vision. In such cases, the surgery offers much needed relief from vision obstruction.

When surgery is not done perfectly, there can be scarring called “sausage”. The reason we call it a sausage is when the fold is too big or when the muscle tissue right below the fold was removed excessively. In such cases we need to remove the sausage and do surgery once more. So, it is important to do surgery skillfully. And if sausages appear, we can remove them and redo the surgery.

Countries in Asia, especially South Korea, have ample experience in this type of surgery. There are many surgeons who are considered experts and have a long wait list. Through CloudHospital, you can book your procedures in an expeditious manner.