Doctor, I want a double eyelid but do I need an epicanthoplasty? 医生，我想有双眼皮，但我需要开眼头吗？

In my previous blog, I discussed about the difference between having double eyelid surgery alone vs double eyelid & epicanthoplasty. This blog talks about the different types of epicanthal fold and how to determine if epicanthoplasty is needed.

It is important to first identify if you have an epicanthal fold. If you do, what is the type of epicanthal fold because this will determine the amount of correction needed. You can see for yourself in the mirror if your caruncle is covered by a fold of skin.

There are 4 main types of epicanthal fold whereby only 3 types require correction. 

Type I is when the lacrimal lake or caruncle is fully exposed and no correction is needed.

Type II-III are the most common ones that I come across in Malaysia, with varying degrees of severity.

Type IV is relatively rarer.

The description of various epicanthal fold is illustrated below.

I routinely recommend epicanthoplasty for most (but not all) of my patients now because I really do think that creating double eyelid combined with epicanthoplasty has a more superior and accentuated effect. In selected individuals, correcting epicanthal fold will allow full exposure of the inner eye corner and lacrimal caruncle. This will further increase the horizontal eye aperture and overall widen the eyes that makes it brighter, more attractive and easier to apply eyeliner. With epicanthoplasty, I can also decide to create a tapered or parallel eyelid crease, depending on patient's desire. 

Epicanthoplasty surgery needs precision and skill to achieve favorable outcome. The most common complication associated with this surgery is scarring. The inner eye corner is multi contoured and the skin is really thin. Incision made here has to be so precise that it is hidden so that no visible scar is noticeable after healing. 

This patient had a low eyelid crease and a mild Type II epicanthal fold especially in the left eye.
She wanted a natural crease and correction of epicanthal fold.
She underwent suture double eyelid and epicanthoplasty correction.
Picture here is before and 3 days after. 

This patient had thicker and puffy eyelid and an unusual Type IV epicanthal fold.
You can observe that the fold originated from below and curved upwards.
She also wanted a natural crease and reduce the eyelid puffiness.
She underwent incisional double eyelid and epicanthoplasty correction.
This is before and 1 week after.