What Are Epicanthic Folds?
March 1, 2026
Epicanthic folds: anatomy and variation
An epicanthic fold is a small crescent of skin that drapes from the upper eyelid across the inner corner of the eye, partly covering the lacrimal caruncle, the pink nodule there. Clinical writing also spells it epicanthal fold, and older sources call it the Mongolian fold. You see it in most East and Southeast Asian populations, in many Central Asian, Indigenous American, and southern African groups, and as a normal developmental trait in young children of any ancestry. Anatomists describe four subtypes that differ in where the fold starts and how it sits over the lid: tarsalis, inversus, palpebralis, and supraciliaris (Park, 2015; PMC4536067). It is a normal anatomical variant rather than a defect, though this page also covers the surgical techniques used when someone asks to have it corrected.
A subtle epicanthic fold drapes across the inner eye corner, partly covering the lacrimal caruncle. Anatomists call this region the medial canthus.
Why do epicanthic folds affect facial aesthetics?
Epicanthic folds usually go along with the nasal bridge, and people with prominent folds tend to have lower bridges than those with higher ones. The folds are also tied to ancestry, certain health issues, ageing, and congenital conditions such as Down syndrome. The procedure used to remove them, epicanthoplasty, is one of the trickier operations: it can affect the lacrimal canals that drain tears, it tends to leave scars, and it usually needs other corrective work alongside it.
Even in groups without prominent epicanthic folds, the neoclassical eye-spacing canon (intercanthal distance equal to palpebral fissure length) rarely holds. In a sample of 203 young adults, intercanthal width exceeded fissure length in 73 percent of Afro-Americans and 51.5 percent of North American Caucasians (Farkas et al., 2000). The fold visually accentuates that same variation.
What causes epicanthic folds?
Epicanthic folds form when extra skin grows over a low nasal bridge. Several things feed into them, including age, ancestry, and certain health problems.
Age
Epicanthic folds usually disappear during pregnancy, before the fetus is six months along. Some babies are still born with them, though, and the folds can stick around or come back as a child grows. They generally clear up for good once the nasal bridge has fully developed.2
Ancestry
Epicanthic folds are common in certain ethnicities, including Asians, Native Americans, and the Malagasy. They are a defining feature of some populations, showing up in nearly 90% of East and Southeast Asians.3
Certain medical conditions
Epicanthic folds are sometimes one feature of a medical condition, especially congenital ones where the nasal bridge fails to mature and the folds are free to grow. About 60% of people with Down syndrome have them. They also turn up in Williams syndrome, Noonan syndrome, blepharophimosis syndrome, phenylketonuria, Rubinstein-Taybi syndrome, Turner syndrome, and Zellweger syndrome.4
Fetal alcohol syndrome
Fetal alcohol syndrome comes from a pregnant woman drinking alcohol. It causes brain damage and growth problems, and although the features vary from one child to the next, the damage cannot be reversed. Children with the syndrome often have prominent epicanthic folds.5
How to prevent epicanthic folds?
Some causes, like Down syndrome and ageing, cannot be avoided. Others, like fetal alcohol syndrome, can be. And because the folds are so common in certain Asian ethnic groups, where they come down to facial genetics, there is no real way to prevent those.
Use makeup
Women with prominent folds who cannot or would rather not have surgery can hide them with makeup. There are plenty of techniques that conceal the folds completely.
Avoid alcohol during pregnancy
Drinking during pregnancy does serious damage to a child's brain, growth, and development, epicanthic folds included. Avoiding alcohol while pregnant is the way to keep fetal alcohol syndrome from happening in the first place.
How to treat epicanthic folds?
Surgery is rarely needed, since the folds clear up on their own in almost every case once the nasal bridge develops. Several surgical options exist, though, for the rare times the folds interfere with vision.
'V' operation
For mild folds, this may be the best option. It is a simple procedure, usually done for cosmetic reasons in non-Asian patients.
The five-flap technique
This technique is for difficult cases and broad epicanthic folds. It removes the excess muscle and deep tissue under the inner folds, and studies show it is the best choice when the folds count as a deformity. It needs about a year of regular follow-up, and the results are satisfying in nearly all patients.6
'Y-V' operation
People with moderate epicanthus can do well with this procedure, especially if the folds have not fully affected their vision yet. It is effective, it has been used for decades, and it is even simpler than the 'V' operation.7
Z-plasty
This procedure has been refined several times for the best result. It is reserved for the most complex cases because it is difficult and needs a plastic surgeon who specialises in it. The idea is to build a new epicanthus, and it suits every type of fold, with good results in most cases.8
Pang's eyelid crease technique
This one is popular among Asian patients for fixing problems with the eyelid crease and improving its shape, height, depth, and softness. It thickens the fibrous tracts of the eyelid by creating adhesion between the skin and the upper edge of the tarsus. Epicanthic folds are usually corrected at the same time as the rest of the crease, mainly for cosmetic reasons.9
HA-based injectables
These are usually used to gauge how severe the condition is and how it might be solved surgically. Some cases respond to hyaluronic acid injections, but most still need surgery. Dermal fillers often follow a surgical procedure to improve the result and smooth over any scarring left by the blepharoplasty.10
The same face shown at four levels of fold prominence, with identity, lighting and framing kept constant. Clinicians grade prominence by how much of the lacrimal caruncle the fold obscures: less than a third reads as mild, more than half as moderate, and near-complete coverage as prominent. Surgeons pick the technique mostly from that grade.