Is Double Eyelid Surgery Enough? When Upper Epicanthoplasty Is Needed

Hello, this is Baba Plastic Surgery.

One of the most common questions from people considering double eyelid surgery is, “Do I really need to have upper epicanthoplasty as well?”

When the eye shape looks cramped or the desired double eyelid line does not form well, whether to combine upper epicanthoplasty can become an important decision point. Today, I’ll explain in detail the relationship between double eyelid surgery and upper epicanthoplasty, as well as when combined surgery is needed.

What Is Upper Epicanthoplasty

A procedure that removes the skin covering the upper part of the lacrimal caruncle

Types of eye corner surgery

Inner corner surgery, outer corner surgery, lower corner surgery

First, upper epicanthoplasty should be distinguished from inner corner surgery, outer corner surgery, and lower corner surgery.

Inner corner surgery opens the inner corner of the eye, while outer corner surgery opens the outer corner, directly lengthening the horizontal width of the eyes. Lower corner surgery makes more of the white part visible in the lower outer area of the eye, helping the outer corner look a little more open.

Finally, upper epicanthoplasty is a procedure that opens up the eyelid line by removing the skin covering the front of the double eyelid line, allowing the line to extend farther toward the inner side.

Effects of Upper Epicanthoplasty

In-out line + upper epicanthoplasty

Semi-out line + upper epicanthoplasty

These days, most patients prefer a double eyelid line that extends clearly and neatly toward the inner side. Especially when someone wants an in-out line, if upper epicanthoplasty is not performed at the same time, the inner corner may remain covered, making the overall double eyelid line look shorter.

For that reason, the opening tends to extend a bit more than with a semi-out line. In the case of a semi-out line, the line is generally well opened outward, so the length of the line may be sufficient, but because the inner corner can fold inward, it may create the illusion of an in-out line. Therefore, when performed together to extend the line outward, the eye shape can be improved to look more open.

When upper epicanthoplasty is needed

• When the Mongolian fold is thick and the inner corner of the eye looks cramped

• When the eyes still look small or cramped after creating a double eyelid

• When the inner eyelid line is structurally blocked or asymmetrical

• When you want a more open, refined impression

In particular, when the inner corner is heavily covered, it may be difficult to achieve the desired eye shape with double eyelid surgery alone. If performed together with upper epicanthoplasty, the horizontal width expands, creating a much more open and softer impression.

When upper epicanthoplasty is performed alone

A double eyelid line that looks bent / A double eyelid line that has loosened

If performed alone without being combined with double eyelid surgery, the existing double eyelid line may overlap with the line of the epicanthoplasty, creating a step or causing the original line to loosen. For this reason, we recommend performing upper epicanthoplasty together with double eyelid surgery.

A double eyelid with a sausage-like line

Conversely, if the front part of the double eyelid line is swollen like a sausage, the direction of upper epicanthoplasty can be reversed— that is, opening downward—to improve the sausage-like double eyelid line.

How to achieve successful upper epicanthoplasty

In the case of eye corner surgery, because the procedure is done through an incision, a small scar may remain. The incision for upper epicanthoplasty should be designed to match the double eyelid line, and if the incision position is properly adjusted, it can look naturally like the double eyelid line while minimizing the appearance of scarring.

Average incision mm for upper epicanthoplasty

The average incision length for upper epicanthoplasty is 5 mm to 6 mm. However, depending on the case, if the Mongolian fold at the inner corner covers too much, an incision of up to 1 cm to 1.5 cm may be necessary.

So today, I wrote about the relationship between double eyelid surgery and upper epicanthoplasty. Rather than always combining eye corner surgery, it is most important to receive a specialist’s diagnosis based on your own eye structure and skin condition and proceed with an accurate plan. Double eyelid surgery alone can certainly create beautiful eyes, but for certain eye structures, combining upper epicanthoplasty can create a much more natural and defined eye shape.

Finding the procedure that suits you through an accurate consultation and diagnosis is the first step toward natural, regret-free results.