Epicanthal folds or mongolian folds are semilunar folds of skin extending from the upper eyelid across the medial canthal area to the margin of the lower eyelid medially. It exists as a normal racial characteristic in large sections of the world's population throughout Asia and the Americas. There are four types of epicanthus; epicanthus supraciliaris, epicanthus palpebralis, epicanthus tarsalis and epicanthus inversus. The most common types found in Asia are epicanthus palpebralis and epicanthus tarsalis. Various treatment have evoloved to remove the epicanthal folds as a result of the growth in double-fold cosmetic operations in Asia. Without the removal of the epicanthal fold prior or during double-fold operations, the final outcome is unnatural and unattractive. But removal of the epicanthal fold is difficult and often leads to undesirable scarring. This makes many plastic surgeons reluctant to perform the procedure. However, surgical experience with the Uchida epicanthoplasty has shown it to be highly effective in epicanthal fold removal while elimination unsightly scarring.
  We employed the split V-W plasty method pioneered by Uchida on 106 cases over the past 3 years. The age distribution of these cases was 14 to 52 years of age with a average age of 25.6. The proportion of male to female was 4 to 102 respectively. Results obtained in all cases were patient satisfactory. The minute scarring from the operation usually disappeared within 3 months after the procedure especially on the lower eyelid. The procedure involves drawing an isosceles triangle of about 3mm with a vertex in alignment with the horizontal center of the eye on the patient's epicanthal fold. Next is the drawing of arms extending from the base vertices of the triangle outwards parallel to the epicanthal folds of the upper and lower lids of the eye. At this stage, we incise the resultant W with a #15 scalpel. Thereafter, we advanced the incision from the apex of the isosceles triangle linearly towards to the inner canthus with fine scissors. The new medial canthus is then drawn to the apex of the isosceles triangle and sutured with 7-0 nylon. The overlapping skin at the arms of the triangle is then excised and closed with 7-0 nylon. To prevent dog-ear at the lower arm excision site, we extend the orignal incision farther than has traditionally been done (short incision length creates dog-ear).