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Epicanthoplasty
Epicanthoplasty surgery by an expert in the Thonglor area
Medically, the inner corner of the eye (epicanthus) is normally classified into the following types:
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Normal, or open-angle epicanthus
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Epicanthus closed prominently only at the upper part (Epicanthus tarsalis)
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Epicanthus closed at both the upper and lower parts (Epicanthus palpebralis)
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Epicanthus closed prominently only at the lower part (Epicanthus inversus)
This upper-closed epicanthal condition is very commonly found in Asian eyes, especially those of Chinese descent, giving the eyes a shorter appearance with the corners pointing downward (a "Mulan eye" look). A closed inner corner appears pointed, unlike an open corner, which appears rounded — this makes the eyes look smaller and unable to open fully. In severe cases, some people need to raise their eyebrows to help open their eyes, which can cause forehead creases from a young age.
What is Epicanthoplasty?
Epicanthoplasty is a surgery that removes the tight muscle tissue at the inner corner of the eye and rearranges the skin in that area, allowing the full eye to be seen.
There are several epicanthoplasty techniques, divided into two main groups:
1. Advancement flap
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Redraping technique
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VY epicanthoplasty
2. Transposition flap
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Z plasty
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W plasty
The choice of technique depends on the doctor's expertise and the severity of the epicanthal fold.
Who should have epicanthoplasty combined with double eyelid surgery
Many people wonder whether epicanthoplasty is necessary in addition to double eyelid surgery. Consider the following:
Severity of the epicanthal fold
The closed epicanthal fold can be simply divided into three levels of severity, from severe to mild, as shown in the images. In people with an open epicanthus (last image), the pink tissue at the inner corner of the eye, called the caruncle, can be clearly seen. In people with a closed epicanthus, however, skin covers this area, hiding the pink tissue. The more it is covered, the more severe the condition is considered. For example, in the images in order: no caruncle visible at all (severe), a small part of the caruncle visible (moderate), and almost the entire caruncle visible (mild). A closed epicanthal fold makes the eyes look shorter than eyes with an open angle, as can be seen by comparing the before-and-after photos of epicanthoplasty combined with lower eyelash correction, performed without double eyelid surgery.
Severe Moderate
Mild Open corner
Before and after photos of epicanthoplasty and lower eyelash correction at 1 week post-op. Notice how the eyes appear longer after surgery.
2. Desired double eyelid characteristics
Most Thai people with monolid eyes have a closed epicanthal fold and a downward-sloping inner corner. For double eyelid surgery, you can choose a narrower double eyelid where the inner corner remains unchanged (left image), or a full double eyelid crease that extends all the way to the inner corner (right image). For a full crease, the doctor personally recommends always combining it with epicanthoplasty. This is because if the inner corner remains closed while the crease is extended all the way to it, an unnatural-looking crease will result (bottom image).
Currently, many patients — and even some doctors — still don't fully understand the difference between creating a full double eyelid crease and epicanthoplasty, mistakenly thinking they are the same thing, when in fact they are two different procedures.
Therefore, it is essential to consult with a specialist about the pros, cons, and expected results before deciding to undergo double eyelid surgery. In summary, the choice of technique ultimately depends on the patient, since the patient knows best what eye shape they want.
Narrow-angle double eyelid (Nasal taper crease)
Full double eyelid (Parallel crease)
Full double eyelid crease without correcting the inner corner. Notice the eyes still look small, and the closed inner corner makes the double eyelid look unnatural.
Disadvantages of Epicanthoplasty
The main drawback is scarring at the inner corner of the eye. In some people, the scarring can be severe enough to require injections to treat (similar to keloid treatment), and it's difficult to predict who will develop scarring. The scar is most visible at 1 month and will gradually fade over time.
Epicanthoplasty requires great precision in design, correction, and surgical technique, so it must be performed by a doctor with specialized expertise. If you are looking for a clinic to perform epicanthoplasty in the Thonglor area, please contact Saonanon Clinic for more details and a consultation, where treatment is performed by specialist doctors using standardized procedures.
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