The authors found that the results of severe epicanthal fold were excellent after repairing the transposition of the flap and transnasal wiring of the medial canthal tendon. Instead of using the flap transposition and transnasal wiring, we made a 4mm horizontal incision at the epicanthal region and shortened the medial canthal tendon in conjunction with double fold operation of 9 females aging from 16 to 29 (average, 20.6). Ten minutes after the injection of 1% lidocaine-1 : 100,000 epinephrine, an incision was made. Dissection of the medial canthal tendon was made in a careful and intensive manner in order to avoid injuring the angular artery. After full skeletonization of the tendon, an average of 4-6 mm of the tendon was resected and sutured with 4-0 clear nylon. Skin was sewed with two layers of 6-0 nylon. Steri-strips were applied to the wounds for a period of three months. Photo-grammetric analysis of three proportional indices was carried out 6-19 months (average 6.04 months) after the surgery with the use of Photoshop. The proportional indices had intercanthal distance ×100/palpebral fissure width, and upper and lower intere-picanthal distance ×100/palpebral fissure width. Postoperative proportional indices of the three levels were decreased statis-tically: from 159 to 150 at the medial canthus; from 168 to 164 at lower epicanthus; and from 195 to 181 at upper epicanthus. However, these indices increased slightly with time: from 143 to 150 at the medial canthus; from 152 to 164 at lower epicanthus; and from 160 to 181 at upper epicanthus. The resultant scar was short and inconspicuous except for one case which had revealed a white color. A short horizontal incision and shortening of the medial canthal tendon are supposed to be effective techniques to reduce the epicanthal fold, but not a way to completely eliminate the fold with minimal scar. The reason to why the results appeared to worsen with time was probably due to the relapse at the tendon repair. Therefore, over-resection and rigid fixation of the tendon would overcome the relapse.