Epicanthus

How epicanthus forms / Pathophysiology
Types of epicanthus
Causes of epicanthus
Symptoms
Diagnostic tests
Non-pharmacological treatments
Medicines for epicanthus?
Dietary molecular supplements
Regenerative, or stem cell drugs
Surgical options
Prevention
When to see a doctor
What to eat and what to avoid
Frequently asked questions

Epicanthus is a skin fold at the inner corner of the eye. This fold runs from the upper eyelid (and sometimes the lower eyelid) toward the side of the nose and partly covers the inner eye corner where the pink tissue (the caruncle) sits. The fold can be small and barely seen, or it can be wide and very visible. Epicanthus itself is not a disease of the eyeball and does not damage vision by itself. It is mainly a feature of the eyelid skin and how the eyelids and the nose grow and meet each other. In many babies and children the bridge of the nose is flat and the inner eye fold looks larger; as the child grows and the nose bridge rises, the fold may look smaller. In some people the fold stays through life as a normal facial feature. In other people it is part of a bigger eyelid pattern or a genetic syndrome. In a small group, the fold is caused by scarring or surgery and is then called a “cicatricial” or scarring epicanthus.

Epicanthus (also called an epicanthal fold) is a natural skin fold that starts at the upper eyelid and runs down toward the inner corner of the eye near the nose. It partly covers the inner eye corner (the medial canthus). In many people—especially infants and people of certain ancestries—this fold is completely normal and healthy. It does not mean something is wrong with the eye. In most babies, the bridge of the nose is low and flat, and the fold looks more obvious. As the nose bridge grows taller with age, the fold often becomes much less visible on its own.

Epicanthus often makes the eyes look “turned in,” even when the eyes are straight. This false appearance is called pseudostrabismus or pseudo-esotropia. The light reflex test and cover tests help separate a true eye turn from this false impression. Epicanthus can also make the inner corners look farther apart because the fold hides the inner corner landmarks. This can mimic telecanthus (wide inner canthal distance) and is sometimes called pseudotelecanthus. Epicanthus does not automatically mean a problem with tear ducts or with eye muscles, but if tearing, eyelid tightness, or head posture problems are present, a careful eye exam is needed to look for associated issues such as ptosis (droopy lid), blepharophimosis (narrow eyelid opening), or true strabismus.

How epicanthus forms / Pathophysiology

The eyelids are thin skin sheets supported by a firm plate (the tarsus) and moved by muscles. At the inner corner, the lids attach to the bone around the nose and eye via the medial canthal tendon. The skin and a thin muscle called the orbicularis oculi run across this area. In epicanthus, the skin and muscle form a fold that bridges across the inner corner. The shape of the fold depends on where the skin and muscle start, how thick the skin is, how flat or high the nose bridge is, and how the canthal tendon is positioned. Genetics, ethnicity, age, and scarring can change these tissues. In infants, the flat nose and baby fat make the fold look larger. As the nose grows forward and the face lengthens, the fold may appear to shrink. When scarring happens (after trauma or surgery), the skin may pull inward and build a web over the inner corner.

Types of epicanthus

Doctors describe epicanthus by where the fold starts and how it travels. The four classic subtypes below help communicate the anatomy and guide treatment if treatment is ever needed.

Epicanthus tarsalis
This is the most common type in East Asian populations and in many infants of all backgrounds. The fold starts on the upper eyelid skin near the tarsus (the firm lid plate) and crosses toward the nose. The lower lid is less involved. The inner corner is partly covered from above. This type is often symmetrical on both sides. It is a normal facial trait for many families and does not mean there is a medical problem. As a child grows, the fold may soften as the nasal bridge matures, but in many adults it remains as a natural feature.
Epicanthus inversus
Here, the fold is more prominent on the lower eyelid and sweeps upward and inward toward the inner corner. The direction looks “inverted” compared with the typical upper-lid fold. This type is famously associated with Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES). In BPES, the eyelid opening is horizontally short (blepharophimosis), the upper lids are droopy (ptosis), and the inner corner has this upward lower-lid fold (epicanthus inversus). Because several eyelid measurements are altered in BPES, children with this pattern need careful and staged surgical planning.
Epicanthus palpebralis
The fold involves both the upper and lower eyelids fairly equally and spans across the inner corner, sometimes forming a continuous bridge of skin. It may be seen as part of normal variation or with certain syndromes. The degree of coverage over the caruncle (the pink tissue) can vary. The more coverage, the stronger the illusion of crossed eyes and the greater the risk that a true small esotropia could be missed without proper testing.
Epicanthus superciliaris
The fold begins higher, near the eyebrow region, and runs down toward the inner corner. Because it starts so high, this type can create a long sloping curtain of skin over the inner corner. It is less common. When marked, it can contribute to a strong appearance of pseudostrabismus.

Other ways to describe epicanthus:

Congenital vs. acquired: Most epicanthus is present from birth (congenital). When the fold or a web forms after trauma, burns, eyelid surgery, or chronic inflammation, it is acquired (cicatricial).
Isolated vs. syndromic: Isolated means it is the only notable finding. Syndromic means it appears together with other facial or body features as part of a genetic or developmental condition.
Symmetric vs. asymmetric: The folds can look the same on both eyes or different from side to side; asymmetry is common when scarring is the cause.

Causes of epicanthus

Epicanthus can have many causes. Some are normal variants, others relate to facial growth patterns, and some are parts of genetic conditions. Below are twenty clear causes grouped across these ideas.

Normal ethnic facial trait
In many East Asian and some Indigenous, African, and mixed-ancestry populations, epicanthus tarsalis is simply part of normal eyelid anatomy. It is not a disease and does not harm the eyes. It reflects inherited patterns of skin, muscle, and nasal bridge shape.
Infant facial growth pattern (flat nasal bridge in early life)
Babies often have a flat nose bridge and fuller inner eyelid skin. This makes epicanthus more visible. As the child grows and the bridge develops, the fold may become less pronounced without any treatment.
Family trait without other problems
Epicanthus can run in families even outside specific ethnic groups. When parents or siblings have similar folds, a child may inherit the same feature. The fold may stay stable through adulthood.
Prematurity
Premature infants can show more pronounced epicanthal folds due to immature facial growth and soft tissue fullness. As the face and nose mature after birth, the folds may lessen.
Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES)
A genetic eyelid condition that includes a short horizontal eyelid opening, droopy lids, and epicanthus inversus. Children need specialist care and often staged eyelid surgeries to protect vision and improve function and appearance.
Down syndrome (Trisomy 21)
Children with Down syndrome often have characteristic facial features that can include epicanthal folds. The folds themselves are not harmful, but these children also need routine vision screening for refractive errors, cataracts, and strabismus.
Fetal Alcohol Spectrum Disorders (FASD)
Prenatal alcohol exposure can produce a pattern of facial differences, growth issues, and neurodevelopmental effects. Epicanthal folds can be part of the facial pattern seen in some affected children.
Noonan syndrome
Noonan syndrome can include specific facial features such as down-slanting palpebral fissures and, in some, epicanthal folds. Eye alignment and vision should be checked because other ocular issues can co-occur.
Turner syndrome
Some girls with Turner syndrome show epicanthal folds as one of several facial features related to the condition. Regular eye checks remain important.
Williams syndrome
Characteristic facial traits in Williams syndrome may include periorbital fullness; epicanthal folds can appear in some cases. These patients need individualized medical and developmental care.
Trisomy 13 (Patau syndrome) and Trisomy 18 (Edwards syndrome)
These chromosomal conditions have many facial and systemic findings; epicanthal folds may be present. Specialized pediatric care is always required.
Smith-Lemli-Opitz and other metabolic or genetic conditions
Several genetic or metabolic syndromes list epicanthal folds among variable facial features. A geneticist helps decide when to test and how to interpret results.
Prader–Willi and some other neurodevelopmental syndromes
In some children, epicanthal folds accompany other facial features. The presence of a fold alone does not diagnose a syndrome, but in context it can be a helpful clinical sign.
Ehlers–Danlos spectrum or connective tissue laxity (rare association)
Generalized skin laxity and tissue differences can alter eyelid drape. Epicanthal folds are not a classic hallmark but can appear as part of eyelid skin redundancy in certain patients.
Medial canthal scarring after trauma or burns (cicatricial epicanthus)
Skin healing can pull across the inner corner and create a web or fold. This is an acquired cause and may need reconstructive surgery if it blocks the corner or causes symptoms.
Post-surgical scarring (after blepharoplasty, medial canthoplasty, or lacrimal surgery)
Scar formation or over-tightening can create or worsen a fold across the inner corner. Careful surgical planning and gentle tissue handling reduce this risk; revision surgery may correct it.
Chronic eczema or dermatitis around the inner corner
Repeated inflammation and rubbing can thicken or fold the skin near the inner canthus. Treating the skin condition can reduce irritation; established scarring may persist.
Congenital craniofacial differences
Conditions that change mid-face growth or nasal development (for example, midface hypoplasia) can make epicanthal folds more visible by altering the local skin and bone support.
Myxedema or eyelid edema that mimics a fold
Generalized swelling from thyroid disease or other causes can create a hooded look near the inner corner that resembles epicanthus. When swelling improves, the pseudo-fold may lessen.
Age-related medial hooding mimicking epicanthus
In older adults, extra skin and soft tissue at the eyelids sometimes droops over the inner corner and looks like a fold. This is not classic congenital epicanthus but can appear similar.

Symptoms

Epicanthus by itself is usually harmless. Many people have no symptoms and live comfortably with it. When symptoms or effects happen, they are usually cosmetic or social, or they relate to confusion about eye alignment. Below are fifteen plain-language points.

Visible inner-corner skin fold
The fold is seen as a bridge of skin covering the pink inner corner. It can be mild or broad.
Appearance of “crossed eyes” in photos (pseudostrabismus)
Because the inner white of the eye is partly covered, the eyes can look turned in, especially in photographs or in side gazes. The eyes may, in fact, be straight.
Apparent smaller eye opening
The fold can make the eye look smaller near the nose, even when the true eyelid opening is normal.
Inner corners seem wide apart (pseudotelecanthus)
By hiding the true inner corners, the fold makes the inner corner landmarks look farther apart.
Cosmetic concern
Some people feel self-conscious about how the inner corners look. Concerns often relate to symmetry, makeup application, or how eyes appear in pictures.
Parental worry about eye turn
Parents of infants may fear that a baby has crossed eyes. An eye exam often shows the eyes are straight and the fold is creating the illusion.
Skin irritation in the fold
Sweat, tears, or skin conditions (like eczema) can make the skin in the fold irritated or itchy.
Difficulty cleaning the inner corner
The fold can make it a little harder to wipe discharge or crusting from the inner corner.
Tearing or tear pooling (uncommon)
If the fold presses on the punctum (the tiny tear drain opening), mild tearing can occur. True tear duct blockage is not caused by the fold itself but can coexist.
Makeup smudging or limited eyeliner options
Cosmetic placement near the inner corner can be different because the fold covers part of the area.
Masking a true small esotropia
A real inward eye turn can be harder to notice behind a strong epicanthal fold. This is why light reflex and cover tests are important in children.
Association with ptosis or narrow lid opening in BPES
When epicanthus inversus is part of BPES, droopy lids and a short eyelid opening can cause brow fatigue, chin-up posture, and reduced visual field. These are BPES effects rather than the fold alone.
Asymmetry concerns
If one fold is larger than the other, people may notice uneven inner corners and ask for evaluation.
Self-image and social impact
Some children and adults feel teased or judged about eye appearance. Supportive counseling and, when appropriate, surgical options can be discussed.
Photo glare or reflection illusions
Light reflecting off the covered inner sclera can exaggerate the look of crossing in photos, worsening the pseudostrabismus impression.

Diagnostic tests

A careful exam focuses on ruling out true eye misalignment, measuring eyelid features, and checking for any associated conditions. Not every test below is needed for every person. Doctors pick tests based on age, symptoms, and context. To meet your request, the list is grouped into Physical Exam, Manual Tests, Lab/Pathological, Electrodiagnostic, and Imaging—with four tests in each group (total 20).

A) Physical exam

Standard eyelid and facial inspection with epicanthus typing
The doctor looks at the inner corners from the front and side, checks how much of the pink caruncle is covered, and classifies the fold (tarsalis, inversus, palpebralis, or superciliaris). They note symmetry and whether the fold looks congenital or acquired.
Anthropometric measurements (ICD, OCD, IPD)
The inner canthal distance (ICD), outer canthal distance (OCD), and interpupillary distance (IPD) are measured with a ruler or caliper. These numbers show whether there is real telecanthus (widened ICD) or only the illusion from the fold.
Eyelid measurements (MRD1, MRD2, palpebral fissure height/length, levator function)
MRD1 measures the distance from the corneal light reflex to the upper lid edge; MRD2 does the same for the lower lid. Palpebral fissure height and length are recorded. Levator function checks how strongly the upper lid lifts. These help identify ptosis or blepharophimosis that may accompany some epicanthus types.
Standardized photography in primary and nine gaze positions
Front, oblique, and side photos with consistent lighting document the fold and eyelid proportions. This aids comparison over time and helps with surgical planning if desired later.

B) Manual tests

Hirschberg corneal light reflex test
A small light is shone at the eyes; the reflection should center similarly on both corneas if the eyes are straight. If the reflex sits off-center in one eye, a true deviation may be present. This simple test helps separate pseudostrabismus from real strabismus.
Cover–uncover and alternate cover tests
Covering one eye and then the other reveals any hidden eye turn. If the uncovered eye moves to take up fixation, there is strabismus. If neither eye shifts, the “crossed-eye” look is likely only from the epicanthal fold.
Medial skin stretch (epicanthal simulation) test
The examiner gently stretches the inner eyelid skin laterally to see how the inner corner would look if the fold were reduced. This helps predict cosmetic change after epicanthoplasty and can reassure parents about the effect of growth.
Cycloplegic retinoscopy/refraction
After drops temporarily relax the focusing muscle, the doctor measures true refractive error. Significant farsightedness with inward turns (accommodative esotropia) can coexist. Correcting the refractive error prevents amblyopia and avoids blaming the fold for a real alignment problem.

C) Lab and pathological tests

Genetic testing for BPES (FOXL2) when features suggest it
If a child has epicanthus inversus together with short eyelid slits and ptosis, FOXL2 testing can confirm BPES and guide timing of staged surgeries and counseling.
Karyotype or chromosomal microarray when a syndromic pattern is present
When other features suggest chromosomal conditions (e.g., Trisomy 21), chromosomal testing confirms the diagnosis and prompts system-wide care. Epicanthus becomes one facial feature within a broader plan.
Thyroid function tests if eyelid edema or myxedema is suspected
If swelling around the inner corner mimics a fold, checking thyroid status helps identify a reversible cause. Managing the thyroid issue can reduce the pseudo-fold.
Histopathology of a scarred medial canthus (if surgery is planned)
When epicanthus is due to scarring after burns or trauma and tissue is excised, pathology shows fibrous tissue and confirms the acquired, cicatricial nature. This is not routine in typical congenital epicanthus.

D) Electrodiagnostic tests

Visual Evoked Potential (VEP) in difficult amblyopia assessments
If a young child cannot cooperate with eye charts and amblyopia is suspected (for example, if a true eye turn is present but hard to quantify due to the fold), VEP helps estimate visual pathway function objectively.
Electroretinography (ERG) when retinal disease must be excluded
Epicanthus does not damage the retina. However, if visual responses are poor and a retinal condition is suspected, ERG confirms retinal function so the team does not miss another cause of low vision.
Objective eye-tracking or fixation stability recording (where available)
Digital eye-tracking can document fixation stability and alignment during viewing tasks, supporting or refuting subtle strabismus that could be hidden by the fold.
Pupillography or automated pupillary light reflex analysis (rarely needed)
Automated measurements of pupil reactions can assist in complex pediatric visual assessments when cooperation is limited. This is seldom required for isolated epicanthus but may appear in comprehensive centers.

E) Imaging tests

3-D surface stereophotogrammetry or structured-light facial scanning
These non-invasive scans capture the 3-D shape of the eyelids and nose, quantify the fold, and allow precise before–after comparisons if surgery is considered or to track natural changes as a child grows.
Craniofacial CT or low-dose 3-D imaging when broader anomalies are suspected
If the doctor suspects midface or nasal bone differences beyond the eyelids, imaging can map bones and guide craniofacial planning. Imaging is not routine for simple epicanthus.
Cephalometric radiographs in orthodontic/craniofacial planning
Lateral and frontal cephalograms sometimes assist a multidisciplinary team when facial proportions, dental occlusion, and nasal development are being planned together with eyelid surgery.
Dacryocystography or dacryoscintigraphy if tearing suggests tear-drain issues
If there is persistent tearing and exam suggests a drainage problem, imaging the tear duct helps confirm the site of blockage. This is not caused by epicanthus itself but can coexist.

Non-pharmacological treatments

Honesty first: No cream, exercise, or gadget has been proven to “melt” or “remove” an epicanthal fold. Most non-surgical steps are about comfort, confidence, and appearance while growing, or about planning if surgery might be helpful later.

Watchful waiting in children
Description: Simply allow natural facial growth.
Purpose: Many folds fade as the nose bridge grows.
Mechanism: Growth of nasal bones and midface stretches the inner corner skin.
Education and reassurance
Description: Explain the difference between pseudoesotropia and true strabismus.
Purpose: Reduces anxiety and prevents unnecessary treatments.
Mechanism: Clear information changes decisions and expectations.
Regular vision checks
Description: Age-appropriate eye exams.
Purpose: Detect real strabismus, refractive error, or amblyopia early.
Mechanism: Early detection allows timely treatment unrelated to the fold.
Cycloplegic refraction and glasses if needed
Description: Strong farsightedness can mimic crossing; glasses correct it.
Purpose: Prevent amblyopia and eye strain.
Mechanism: Clear focus reduces inward eye turn in accommodative esotropia.
Photo angle optimization
Description: Take photos slightly off-axis with good lighting.
Purpose: Avoid the false “crossed” look in pictures.
Mechanism: Changes the way light reflects from the cornea.
Make-up and grooming tips (for adults)
Description: Inner-corner highlighting and brow shaping by a professional.
Purpose: Balance the perceived inner corner coverage.
Mechanism: Light/dark contrast guides visual attention.
Glasses frame selection
Description: Choose bridge shape and lens size that complements inner corners.
Purpose: Reduce attention to the fold and improve comfort.
Mechanism: Frame geometry changes facial focus points.
Skin care for eczema/allergies (non-drug steps)
Description: Gentle cleansing, cool compresses, avoid rubbing triggers.
Purpose: Reduce swelling that can exaggerate the fold.
Mechanism: Less irritation means less puffiness.
Sun protection
Description: Sunglasses and broad-brim hats.
Purpose: Protect delicate inner-corner skin.
Mechanism: UV avoidance preserves skin quality.
Camouflage for special events
Description: Temporary skin-safe tape or professional makeup for photos.
Purpose: Short-term appearance change.
Mechanism: Mechanical repositioning or optical illusion.
Psychosocial support
Description: Counseling if teasing or self-image issues occur.
Purpose: Protect mental well-being.
Mechanism: Skills and support reduce stress and improve confidence.
Manage rubbing habits
Description: Treat underlying itch and teach gentle eye care.
Purpose: Prevent irritation and swelling.
Mechanism: Less friction reduces chronic puffiness.
Allergen avoidance measures
Description: Keep dust/pollen low at home; use saline rinses.
Purpose: Decrease allergic swelling.
Mechanism: Lower allergen load → less edema.
Posture and sleep hygiene (indirect)
Description: Enough sleep, head elevation if puffy.
Purpose: Reduce morning eyelid swelling.
Mechanism: Less fluid pooling in eyelid tissues.
Healthy weight and hydration
Description: Balanced diet, adequate fluids.
Purpose: General skin health.
Mechanism: Supports skin elasticity; does not remove the fold.
Avoid unproven gadgets
Description: No “nose bridge clips,” massage rollers, or “eye exercises.”
Purpose: Prevent harm and wasted money.
Mechanism: These do not change bone growth or skin anatomy.
Allergy-proof cosmetics
Description: Use hypoallergenic products near inner corners.
Purpose: Minimize irritation that can accentuate folds.
Mechanism: Fewer reactions → less swelling.
Occupational advice for professionals on camera
Description: Lighting angles and make-up artistry.
Purpose: Achieve the desired look safely.
Mechanism: Visual framing directs viewer attention.
Pre-surgical counseling (if considering surgery)
Description: Discuss goals, scars, and realistic outcomes.
Purpose: Informed decision-making.
Mechanism: Expectations aligned with surgical limits.
Facial photography for monitoring
Description: Periodic standardized photos in children.
Purpose: Track natural change before deciding on surgery.
Mechanism: Objective comparison over time.

Medicines for epicanthus?

Core truth: There is no medicine that removes an epicanthal fold. Drugs may help related issues (like allergy swelling, eczema, or care after surgery), but they do not correct the fold itself.

Lubricating eye drops (as needed)
Purpose: Comfort if there is dryness or irritation from rubbing.
Safety: Generally safe; preservative-free preferred for frequent use.
Allergy eye drops (antihistamine/mast-cell stabilizers)
Purpose: Reduce itch and swelling that can make folds look puffier.
Safety: Use under pharmacist or clinician guidance.
Short courses of low-potency topical steroid for eyelid eczema
Purpose: Calm flares when prescribed.
Safety: Doctor-supervised only; eyelid skin is thin and sensitive.
Topical calcineurin inhibitors (e.g., pimecrolimus/tacrolimus) for eczema
Purpose: Steroid-sparing therapy for chronic eyelid dermatitis.
Safety: Prescribed and monitored by a clinician.
Oral antihistamines (as needed)
Purpose: Reduce systemic allergy symptoms that worsen puffiness.
Safety: May cause drowsiness; dosing individualized.
Antibiotic ointment (only if bacterial skin infection occurs)
Purpose: Treat secondary infection from scratching.
Safety: Short, targeted courses only.
Post-operative antibiotic drops/ointment (after surgery)
Purpose: Prevent infection while the incision heals.
Safety: Surgeon-directed regimen.
Post-operative pain control (acetaminophen, etc.)
Purpose: Comfort after surgery.
Safety: Use as directed; avoid NSAIDs if surgeon advises.
Silicone scar gel or sheets (topical, after incision heals)
Purpose: Support scar maturation after epicanthoplasty.
Safety: Start only when the wound is closed; follow surgeon’s advice.
Sunblock on scars (broad-spectrum)
Purpose: Prevent scar darkening after surgery.
Safety: Mineral sunscreens are gentle for eyelid-adjacent skin.

Why no dosages listed? Dosing depends on age, weight, diagnosis, and safety needs—eyelid skin and eyes are delicate. Always follow your clinician’s exact instructions.

Dietary molecular supplements

Straight talk: No vitamin, herb, or “molecular supplement” has been shown to remove an epicanthal fold. Nutrition supports general skin health and post-surgical wound healing only.

Protein-adequate diet: supports collagen for healing if surgery is done.
Vitamin C: supports collagen cross-linking in wound repair.
Zinc: cofactor for healing enzymes (avoid excess).
Vitamin A (food sources): general skin integrity (avoid high-dose supplements).
Omega-3 fatty acids: may support tear film comfort; no effect on folds.
Vitamin D (correct deficiency only): general health; not fold-specific.
B-complex from food: overall tissue health.
Hydration: keeps skin supple but does not change fold anatomy.
Fruits and vegetables: antioxidants for skin wellness.
Avoid megadoses and “detox” products: no evidence and potential harm.

Regenerative, or stem cell drugs

Important safety message: There are no immune boosters, regenerative drugs, or stem cell treatments that fix epicanthus. Any such claims are unproven and may be unsafe or unethical. The fold is a skin and facial-bone anatomy feature, not an immune problem. If someone offers injections, stem cells, or “regenerative serums” to remove an epicanthal fold, seek a qualified medical opinion and avoid the procedure.

No stem cell product is approved to treat epicanthus.
No immune drug changes the inner corner fold.
“Booster” shots or drips for folds lack evidence.
Off-label fillers near the inner corner can be risky and are not a treatment for epicanthus.
Platelet-rich plasma (PRP) does not correct epicanthal skin anatomy.
Best practice is either observation or planned eyelid surgery when appropriate.

Surgical options

When is surgery considered?

For cosmetic reasons in older children or adults who understand benefits and scars.

As part of repairing other eyelid problems (e.g., BPES).

When the fold significantly hides the inner canthus or interferes with other planned eyelid surgery (like double-eyelid blepharoplasty).

Medial epicanthoplasty (Z-plasty variants)
Procedure: Small triangular skin flaps are rearranged at the inner corner to reduce the fold and reveal the caruncle (pink inner corner).
Why: Proven, versatile method with scars placed along natural skin lines.
Y-V advancement epicanthoplasty
Procedure: A Y-shaped incision is advanced and closed as a V to release the fold.
Why: Useful when skin needs to be advanced without long scars.
Mustardé-type or V-W plasty techniques
Procedure: Different geometric flap patterns to re-drape skin at the inner corner.
Why: Tailored to skin amount, tension, and scar placement preferences.
Combined medial canthoplasty with epicanthoplasty (for BPES/telecanthus)
Procedure: Tightening or repositioning the medial canthal tendon plus skin flap work.
Why: Corrects increased distance between inner corners and the fold together.
Epicanthoplasty combined with double-eyelid (crease) surgery
Procedure: Addresses the fold while creating or refining an eyelid crease if desired.
Why: Single-stage aesthetic plan for balanced inner and upper lid appearance.

Risks and recovery (brief): bruising, swelling, infection, visible or raised scars, asymmetry, under- or over-correction, need for revision, and rare tear drainage issues. Scar care and sun protection matter. Choose an experienced oculoplastic or facial plastic surgeon.

Prevention

You cannot “prevent” a normal genetic/anatomical fold.
Avoid eye rubbing to reduce swelling that can exaggerate the look.
Treat allergies/eczema promptly to minimize puffiness.
Use sun protection to keep inner-corner skin healthy.
Choose hypoallergenic cosmetics near the inner corner.
Avoid unproven devices that claim to change the nose bridge or fold.
For infants, allow normal facial growth before considering appearance changes.
Keep regular pediatric/eye check-ups to rule out true strabismus.
If surgery is planned, follow pre-/post-op instructions closely for best scars.
Maintain overall health and nutrition—good for skin and healing, even if it does not remove the fold.

When to see a doctor

If your child appears cross-eyed, even if you suspect pseudoesotropia—get an eye alignment exam.
If there is eye redness, pain, discharge, or vision changes.
If the inner corner skin has recurrent eczema, swelling, or infection.
If you or your child feel bothered by the appearance and want to discuss options.
If there are other facial or eyelid differences suggesting a syndrome (small eye openings, droopy lids, increased distance between inner corners).
Before any cosmetic procedure, to understand realistic outcomes and risks.

What to eat and what to avoid

Diet will not change an epicanthal fold. Nutrition matters only for general skin wellness and for healing if surgery is done.

Helpful to eat:

Balanced meals with lean protein, fruits, vegetables, whole grains, and healthy fats (e.g., fish, nuts).
Vitamin C–rich foods (citrus, berries, peppers) for collagen support after surgery.
Zinc-containing foods (legumes, seeds, seafood) in normal amounts.
Adequate water.

Best to avoid or limit:

Very high-salt foods right before photos or events (salt can increase puffiness).
Excess alcohol, which may worsen swelling and impair healing.
Megadose supplements that claim to “reshape” eyelids—no evidence and possible risks.

Frequently asked questions

Will my child’s epicanthal folds go away?
Many lessen as the nose bridge grows, especially between ages 3–7.
Does epicanthus cause crossed eyes?
No. It can mimic crossing (pseudoesotropia), but it does not cause real strabismus.
Do creams or exercises remove the fold?
No. There is no proven topical or exercise that changes this anatomy.
Is surgery the only way to change the fold?
Yes. Epicanthoplasty is the effective method when change is desired.
What age is best for surgery?
Usually when facial growth is more advanced and the person can participate in decisions. Some syndromic cases are done earlier by specialists.
Will surgery leave a scar?
Yes, but skilled surgeons place scars along natural lines to be less visible over time.
Can glasses or make-up help?
They can change the appearance and draw attention away from the inner corner, but they do not remove the fold.
Is epicanthus harmful to vision?
By itself, no. Vision issues only occur if there are separate problems like strabismus or refractive error.
Is epicanthus common in certain populations?
Yes, it is a normal trait in many East Asian and some Indigenous and other populations.
Can allergies make my folds look stronger?
Yes. Puffiness from allergies can accentuate them temporarily.
Are stem cells or fillers useful?
No. They are not treatments for epicanthal folds.
How long is recovery after surgery?
Swelling and bruising usually improve over 1–2 weeks; scars soften over months. Your surgeon will give a timeline.
What are surgery risks?
Infection, scarring, asymmetry, under/over-correction, need for revision, and rare issues near the tear drainage area.
Do I need imaging or genetic tests?
Not for simple epicanthus. Tests are considered only if a syndrome is suspected.
Who should perform epicanthoplasty?
An oculoplastic surgeon or facial plastic surgeon experienced in eyelid surgery.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 28, 2025.

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