Epicanthal fold, also referred to a mongolian fold, is a semilunar fold of skin extending from the upper eyelid across the medial canthal area to the margin of the lower eyelid medially. It is present in fetal life in all races but disappears before birth in all but the mongolian races, who retain it as a characteristic features. In northeast asia approximately 60-86% of the population are known to have it.
There are four types of epicanthus described by Johnson: epicanthus tarsalis, epicanthus palpebralis, epicanthus supraciliaris and epicanthus inversus.
Of these, the epicanthus tarsalis(ET) and epicanthus palpebralis(EP) are most commonly found in the Mongolian. ET arises from the tarsal fold and merges into the skin near the medial canthus. EP arises above the upper tarsus and extends to the inferior orbital rim. The facial features include invisible lacrimal caruncles and narrow palpebral fissures that present a bug-eyed appearance in many patients.
Visible scarring after removing the epicanthal fold was so commonplace that patient satisfaction was low in many cases. To overcome this, the modified Uchida method is proving to be a most advance procedure with high satisfaction results.
I employed the split V-W plasty method, pioneered by Uchida, in 1000 patients over 6 years. The prcedure involves drawing a V equal to an isoceles triangle with arms of 3 mm in length from the vertex. The vertex of the V is aligned with the horizontal center of the eye and touching the epicanthal fold. After the V is drawn, arm are extened from its end outwards parallel to the epicanthal folds of the upper and lower lids, thus creating the W. The length of the arms is determined by the size of the the fold(5-7mm). In cases of ET, the lower arm is slightly shorter (3-5mm) than that of the upper arm of the the resulting W. Once the W is created , this then incised with a #15 scalpel. Thereafter, even tension is applied medially toward and the advancement is made with fine scissors from the apex of the W towards to the inner canthus. The new medial canthus is then drawn to the apex of the W and sutured with 7-0 black nylon. The overlapping skin at each arm is excised and closed not to make any dog-ear formation.