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 at the medial canthus). It is also written as epicanthal fold in clinical literature, and historical sources call it the Mongolian fold. It appears 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 begins and how it sits over the lid: tarsalis, inversus, palpebralis and supraciliaris (Park, 2015; PMC4536067). It is an anatomical variant rather than a defect, though the article also covers the surgical techniques used when correction is requested.
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 Aesthetic?
The nasal bridge is usually associated with epicanthic folds. People with prominent epicanthic folds tend to have lower nasal bridges than people with higher nasal bridges. They are also associated with ancestry, certain health issues, ageing, and congenital anomalies such as Down’s syndrome. Epicanthoplasty is usually used to remove epicanthic folds. It is one of the most challenging procedures since it may affect the lacrimal canals, which are responsible for draining tears. The procedure usually leaves scars and should be followed by other corrective techniques.
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 due to the excess growth and development of the skin over the lower-based nose bridges. Many factors affect the formation of epicanthic folds including age, ancestry, and certain health problems.
Age
Epicanthic folds usually disappear during gestation before the fetus is 6 months old. However, some babies are born with them and they may persist/reappear during the development stages of children. They usually disappear completely when the nasal bridge develops completely. (2)
Ancestry
Epicanthic folds are common in certain ethnicities including Asians, Native Americans, and the Malagasy. It is a characteristic feature of certain populations. Nearly 90% of East and Southeast Asians. (3)
Certain Medical Conditions
Epicanthic folds are sometimes one of the features of certain medical conditions, especially congenital anomalies. These medical conditions are characterized by the failure of maturation of the nasal bridge, which allows the epicanthi folds to grow and appear. 60% of Down syndrome people have epicanthic folds. In addition, Williams syndrome, Noonan syndrome, Blepharophimosis syndrome, Phenylketonuria (PKU), Rubinstein-Taybi syndrome, Turner syndrome, and Zellweger syndrome individuals also have epicanthic folds. (4)
Fetal Alcohol Syndrome
Fetal alcohol syndrome happens due to the consumption of alcohol by pregnant women. It is characterized by brain damages and growth problems. Its features vary from one child to another, but the damages are not reversible. Children with fetal alcohol syndrome usually have prominent epicanthic folds. (5)
How To Prevent Epicanthic Folds?
Some causes of epicanthic folds are inevitable such as Down syndrome and aging. However, other causes such as fetal alcohol syndrome can be avoided. Also, since it's more predominant in certain Asian ethnic groups, it is determined by facial genetics and there are no reasonable ways to prevent them.
Use Makeup
Women who have prominent epicanthic folds, but they cannot get rid of them surgically can hide them via the use of makeup. Many epicanthic fold makeup ideas can hide your epicanthic folds completely.
Avoid Alcohol During Pregnancy
Consuming alcohol during pregnancy causes severe damages to your child’s brain, growth, and development including epicanthic folds. Avoid drinking too much alcohol during pregnancy to prevent Fetal Alcohol Syndrome from happening in the first place.
How To Treat Epicanthic Folds?
Surgical intervention is rare in people who have epicanthic folds since the condition resolves spontaneously in almost all cases due to the development of a nasal bridge. However, several surgical procedures are available if the epicanthic folds intervened with vision.
‘V’ Operation
If you have a mild degree of epicanthic folds, this operation may be the best choice for your condition. It is a simple procedure that is usually done for cosmetic purposes in non-Asian people.
The Five-Flap Technique
This technique is for difficult conditions and broad epicanthic folds. It depends on removing the excess muscles and deep tissues under the medial epicanthic folds. Studies show that this procedure is the best in people whose epicanthic folds are considered a deformity. It also requires 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 benefit from this procedure, especially if their vision is not fully affected by the epicanthic folds yet. It is an effective procedure that has been used for decades to obliterate the epicanthus. It is even simpler than the ‘V’ Operation. (7)
Z-Plasty
This procedure has been modified several times to provide the best results. It is used for the most complex conditions because it is difficult and requires a professional plastic surgeon who specializes in this type of surgery. The principle of this technique is the formation of the new epicanthus. It is suitable for all types of epicanthic folds and the results are good and satisfying in most cases. (8)
Pang’s Eyelid Crease Technique
This procedure is common among Asians to correct any problems with their creases and increase their quality regarding their shapes, height, depth, and softness. The procedure can increase the thickness of the fibrous tracts of the eyelids. The procedure depends on creating adhesion between the skin and the superior tarsal border. Epicanthic folds are usually corrected along with the rest of the creases. It is mainly used for cosmetic purposes. (9)
HA-Based Injectables
They are usually used to address the severity of the condition and figure out how it will be solved surgically. Some cases respond to the injection of Hyaluronic Acid (HA), but most cases need surgical corrections. The use of dermal fillers usually follows surgical procedures to improve the condition and remove any scars that may result due to 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.