![\"Hooded](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/09\/IMG_8470-872x1024.jpg\")
<\/p>\nMany people want the epicanthal fold over the inner corner gone, but hold back from an epicanthoplasty or an upper-corner opening because they are afraid the eyes will end up closer together and look crowded.<\/p>\n
That worry is not a matter of impression; it is a change that can be measured. In a 2024 study of 40 patients who had an epicanthoplasty (medial epicanthal fold surgery), the distance between the inner corners of the two eyes — the intercanthal distance — was reported to fall from an average of 36.6 mm to 32.7 mm, a reduction of about 3.9 mm. Given that the East Asian average sits at around 34.8 to 36 mm, that is enough to change the impression of a face. On top of that, the epicanthal fold is not simply folded skin: it is a fibrous band at the medial canthus that pulls on the inner corner. That calls for an approach which decides the direction the band is released in before deciding how far the corner is opened.<\/p>\n
This post looks in detail at an axis-turned upper-corner opening, which releases the epicanthal fold upward rather than sideways, together with a lateral and lower-corner revision performed on an eye that already showed mucosal exposure, and the course of both at 22 months.<\/p>\n
At the pre-operative assessment this patient presented with two problems of quite different character, one at the inner corner and one at the outer corner.<\/p>\n
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The epicanthal fold covering the inner corner in a hooked shape<\/p>\n
What a case like this needs is not simply a plan to open more, but a design in two parts: defending what has to be protected at the front of the eye, and agreeing clearly on what will be accepted at the back.<\/p>\n
![\"The](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/10\/medial-lateral-canthoplasty-revision-22months-en-body-1.png\")
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The epicanthal fold and the distance between the eyes<\/p>\n
Rather than taking one area as the reference and matching the rest to it, we set a different goal for the front and the back of the eye.<\/p>\n
Four procedures were carried out: epicanthoplasty, an axis-turned upper-corner opening, a lateral canthoplasty revision and a lower-corner revision. Because the flap work at the inner corner and the fixation at the outer corner do not share a surgical field, each proceeds independently of the other.<\/p>\n
It helps to think of the epicanthal fold as a small curtain draped over the inner corner. An epicanthoplasty draws that curtain aside towards the nose — sideways — moving the starting point of the eye inward, so the eye gains horizontal length and the distance between the two eyes inevitably shortens. Taken too far, the eyes can look crowded, or the lacrimal caruncle (the pink tissue at the inner corner) can be exposed to a degree that makes the face look severe.<\/p>\n
An upper-corner opening lifts the same curtain at about 45 degrees — diagonally upward. The eye reads as taller rather than wider, which is why a narrow gap between the eyes is given as a typical indication for it. What we call an axis-turned upper-corner opening adjusts that 45-degree idea to the direction of the band itself. It is our own term for the technique, not a standard name found in the academic literature.<\/p>\n
How much an upper-corner opening actually changes varies a great deal with the original width between the eyes and the shape of the fold.<\/p>\n
![\"Which](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/10\/medial-lateral-canthoplasty-revision-22months-en-body-2.png\")
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The three layers of the eyelid and the one a lower-corner opening moves<\/p>\n
Mucosal exposure is one of the better-known complications of a lateral canthoplasty, and it can occur together with recurrence (the opened area closing again) and with ectropion, in which the lower eyelid turns outward. Mucosal exposure and ectropion matter not only in appearance: both can lead to dry eye, which is why they are treated as conditions for correction and reconstruction.<\/p>\n
Choosing to open further in that situation is therefore not a matter of opening more because the patient asks for it. It is a process of placing the aesthetic gain and the functional risk side by side and agreeing on what will be accepted and what must be prevented at all costs. A little more of the already exposed inner lining showing can be an accepted item; an eye that no longer closes fully, or a lower lid that turns outward, cannot.<\/p>\n
For a lower-corner opening to stay inside the safe line, what is not<\/em> touched matters. The eyelid is a three-layer structure — an anterior lamella of skin and muscle, a middle layer, and a posterior lamella of mucosa and tarsal plate. A lower-corner opening advances only the anterior lamella downward and performs no manipulation at all on the middle and posterior layers.<\/p>\n In a revision, the harder question is not how much to open but whether there is anything left to stitch into. The tendon that holds the outer corner is normally fixed to a small bump on the bone about 5 mm inside the orbital rim, known as Whitnall’s tubercle. If the periosteum covering the bone was damaged or has thinned after an earlier operation, a suture may not hold. The problem is not the button but the cloth it is sewn to, and so a revision has to secure a new anchor point before anything else.<\/p>\n Where the canthal tendon is anchored on the bone<\/p>\n The worry is well founded. An epicanthoplasty opens the inner corner horizontally and moves the starting point of the eye inward, so the distance between the two eyes shortens; measurement has reported an average reduction of about 3.9 mm. In cases like this we consider an axis-turned upper-corner opening, which releases the band of the fold in an upward direction, instead of a simple horizontal epicanthoplasty. How much the gap narrows does depend on the original width and the shape of the fold, so it has to be judged individually after measurement and assessment.<\/p>\n In some cases it can. But opening further means that the existing mucosal exposure has to be carried forward as a structural consequence, and sharing that clearly before surgery comes first. In consultation we establish which the patient values more — a larger eye or complete apposition of the mucosa — and build the plan inside the limit at which functional problems such as dry eye or an outward-turning lid do not arise. Even when further opening is chosen, that line is held.<\/p>\n The flap work at the inner corner and the tendon fixation at the outer corner do not share a surgical field, so they proceed independently. If anything there is an advantage in being able to balance the tension at the front and the back of the eye within a single recovery. Where a revision is involved, however, it has to be confirmed first that enough time has passed since the previous operation for the tissue to have settled and that there is tissue left to fix to; studies on epicanthoplasty revision take a minimum of six months after the earlier surgery as the principle.<\/p>\n What an eye looks like immediately after surgery is a stage, not a result. The maturation and remodelling phase of a wound begins at around three weeks and continues for up to twelve months; an incision reaches its peak tensile strength at about 11 to 14 weeks; and a scar that has finally settled is described as holding about 80 per cent of the strength of tissue that was never injured. Given that the average follow-up in the related literature generally runs to 13 to 15 months, the 22-month mark falls in the range where what is seen is tissue that has already settled.<\/p>\n Before, and 22 months after the four procedures<\/p>\n The changes observed at that point were as follows.<\/p>\n This is one patient’s case, and it was not measured in the same way as the studies cited above, so it should not be read as a reproduction of those figures. The result of any opening procedure varies with the original structure of the eye and the history of earlier surgery.<\/p>\n The stages of wound healing against the 22-month mark<\/p>\n We understand how long a patient may hesitate before deciding on surgery — wanting the fold gone but fearing crowded eyes, or carrying the traces of an earlier operation. The standard in eye surgery does not live in a textbook alone; it also lives in the patient’s own order of priorities, in what they want protected and what they are willing to accept.<\/p>\n We do not recommend opening beyond what is needed. Through a one-to-one consultation we assess the structure of the inner and outer corners, the history of previous surgery, the range a patient can accept and the functional limit that must not be crossed, and propose only the plan that comes closest to the goal we have agreed on. Our aim is an eye you can stand in front of the mirror and be satisfied with for a long time.<\/p>\n How far the gap between the eyes is actually kept<\/p>\n A case from our official Naver blog. The 22-month course is there in photographs.<\/p>\n The before and after photos in this post are published with the patient’s consent.<\/p>\n![\"Whitnall's](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/10\/medial-lateral-canthoplasty-revision-22months-en-body-3.png\")
<\/p>\nFrequently asked questions<\/h2>\n
Does an epicanthoplasty make the eyes look crowded if the gap is already narrow?<\/h3>\n
If a lateral canthoplasty has left mucosal exposure or ectropion, can a revision still open the eye further?<\/h3>\n
Is it too much to have several opening procedures at once?<\/h3>\n
Why the course is only discussed after 22 months<\/h2>\n
![\"Before](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/09\/IMG_8473-1024x596.jpg\")
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![\"Scar](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/10\/medial-lateral-canthoplasty-revision-22months-en-body-4.png\")
<\/p>\nIn closing<\/h2>\n
\n![\"Before](\"https:\/\/sheoneps.com\/blog\/wp-content\/uploads\/2026\/10\/naver-224399397278.jpg\")
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