I answered this question for a patient that already had double eyelid crease but wanted her eyes to look bigger. I noticed in her that she had significant epicanthal folds and this is how I answered her:
An epicanthal fold is the extra fold that you have in the middle part of the eyelid. There are four types of epicanthal folds. Type one is when there is no encroachment on the lacrimal lake (the fleshy part of the eye in the middle of the eye). Type 2 is when there is partial coverage of the lacrimal lake. Type 3 is when there is essentially complete coverage. Type 4 is when the epicanthal fold originates from the lower eyelid which is mostly found in the congenital type of epicanthal fold and in some genetic diseases. Type 2 to 4 can be treated with medial epicanthoplasty type of procedures. There are many different types of procedures that address this. Older types included incisions that crossed the nasal skin which is more likely to scar. Newer procedures keep the incisions in the eyelid skin which is thinner and less likely to scar. You can read my blog regarding the type of epicanthoplasty that I prefer. What this procedure will do is to rearrange the extra skin so that your lacimal lake will be more visible and this will essentiall open up your eyes. The other way to make your eyes bigger is to do a lateral epicanthoplasty where the eye is open wider in the lateral part of the eye which is done less frequently. Botox to the lower eyelid can lead to widening of the eye a little bit as well. Here is video on Asian Blepharoplasty and Medial epicanthoplasty.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington