Background <p>The epicanthal fold affects the aesthetic outcome of blepharoplasty in Asians. Thus, blepharoplasty in scenarios with an unmatched epicanthal fold and double eyelid may lead to unsatisfactory results. Restoring the medial canthal region to harmonize with the double eyelid is vital for achieving an upper-eyelid appearance.</p> Methods <p>In this study, sixteen patients who underwent epicanthoplasty from 2019 to 2023 with a history of unsatisfactory blepharoplasty and an unmatched epicanthal fold were included in this study. The epicanthoplasty was performed based on a four-point homologous design, and the palpebral fissure length (PFL), interepicanthal distance (IED), canthal tilt angle (CTA), and distance from the medial canthus to the beginning of the double-eyelid fold distance (CFD) were recorded preoperatively and 6 months postoperatively.</p> Results <p>In all patients, complete surgical healing was achieved within 2 weeks. The CTA, IED, and CFD significantly decreased after surgical treatment, and PFL increased during the 6-month follow-up. Most patients were satisfied with the results during long-term follow-ups.</p> Conclusion <p>The epicanthoplasty modification described in this study improved the morphology of the upper eyelid, offering stable outcomes and simpler procedures. Further, we described a decision-making strategy for revisional blepharoplasty. This strategy might be an ideal reparative option for patients with unsatisfactory out-fold type double eyelids and the epicanthus not coordinating with the double eyelid, providing a promising alternative for unsatisfactory blepharoplasty.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>