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What is the Epicanthic Fold?

By Alan Rankin
Updated Mar 03, 2024
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The epicanthic fold is a projection of skin between the upper and lower eyelids alongside the nose. It is a common racial characteristic among people with east Asian ancestry. This fold is present in fetuses and infants of any race, and its continued presence can be a sign of a developmental disorder, although this is not always the case.

The epicanthic fold is one of several distinguishing characteristics for persons of Asian descent, particularly those whose ancestors originated in the region from Tibet to Japan. It is also found in Pacific Islanders and Native Americans, who are believed to be descended from Asians, and is not unknown among people of European and African descent. Some scientists speculate that the epicanthic fold may have been an aid to vision for the people residing in or near the Mongolian desert, providing protection from either glare or airborne sand particles. This is only a theory, however, as the genetic background behind such racial characteristics is still not well understood.

Asian people faced systematic racism when migrating to nations such as the U.S. and Australia in the 19th and 20th centuries. The epicanthic fold, as a clear indicator of a person’s racial background, became the target of specific racist epithets. In the mid-20th century, some Asians and Asian-Americans actually elected to have plastic surgery, called epicanthoplasty, to eliminate their folds and make them appear more Western. Epicanthoplasty is a complicated procedure because of the risk of damage to the tear ducts. By contrast, the epicanthic fold is also seen as a sign of exotic beauty in America or Europe, where it is often a rare feature.

The epicanthic fold is sometimes visible during the early development of infants, no matter what their racial background. In non-Asian children, this will often vanish as the facial structure becomes more defined. If this does not happen and there is no racial factor to influence the epicanthic fold, it may indicate a developmental disorder such as Down’s syndrome. This is not always the case, however; concerned parents should consult with a medical professional. In the 20th century, afflicted children with this characteristic were sometimes called Mongoloid because of the epicanthic fold’s association with Mongolian ancestry. This term is now considered imprecise and possibly offensive.

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Discussion Comments

By kylee07drg — On Oct 30, 2011

@Perdido - My cousin went to a surgeon in Los Angeles who is an expert at eye enlargement. The surgeon is Asian himself, so he understands the desire firsthand. He also has extensive knowledge of working with the epicanthic fold.

He was able to redistribute the tissue around the inner eye and lower eyelid to prevent scarring. He made the epicanthic tissue flexible, so this reduced the tension that was holding it in place and hiding her eyes.

He didn't want to totally remove the fold, because that would take away the look of her heritage. He restructured it just enough to make her happy and look natural.

By Perdido — On Oct 29, 2011

I have an Asian friend who is considering having surgery to enlarge her eyes. She has always envied Americans with big blue eyes, and she feels that even if hers were only slightly more open, she would look so much better.

One thing that holds her back from having the surgery is the risk of scarring. Many surgeons refuse to even do the procedure because excessive scarring is likely.

I wonder if there is a surgeon out there who knows how to reduce the epicanthic fold without leaving much scar tissue. If there is, my friend will travel great distances to see him.

By Oceana — On Oct 29, 2011

When my baby brother was born, the doctor could tell by looking at his eyes that he had Down's syndrome. We didn't have any Asians in our family, but his eyes slanted up and outward.

Also, he had the epicanthic fold. This is a sure sign of the syndrome. The doctor saw white patches on his iris, which further confirmed his suspicions.

My mother could tell by looking at his eyes that something wasn't right. Even on that tiny scale, his eyes looked just like those that grown people with Down's syndrome have. The epicanthic fold was really pronounced.

By cloudel — On Oct 28, 2011

I have an Asian friend with an epicanthic fold. She told me that there are three different degrees of it. She has a minimal fold, but some of her relatives have moderate or prominent folds.

Her great-grandfather, who has more pure Asian blood, has a prominent epicanthic fold. It seems to follow the line of his undereye circle until it disappears. His is the most pronounced in the family.

Her parents have moderate folds. They extend a bit further than hers does, but not as far as her great-grandfather's does.

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