Background <p>Medial epicanthoplasty revision is required when prior surgery results in caruncle overexposure or an unnaturally harsh appearance. Achieving a natural medial canthal shape with minimal visible scar remains a surgical challenge.</p> Methods <p>We introduce the Epicanthal mini-redraping reconstruction (EC mini-recon) technique, which involves V-Y advancement of posterior skin lining of the epicanthal fold followed by anterolateral redraping of overlying skin. This retains natural canthal angulation and minimizes the final scar created along relaxed skin tension line (RSTL). From October 2018 to February 2025, 32 patients underwent EC mini-recon, with interepicanthal distance (IeCD) or midline-to-medial canthus distance (MeCD) measured preoperatively and postoperatively using standardized photographs.</p> Results <p>In bilateral cases (n = 16), mean IeCD ratio increased from 2.95 to 3.11 (<i>p</i> &lt; 0.01). In unilateral cases (n = 16), mean MeCD ratio increased from 1.37 to 1.45 (<i>p</i> &lt; 0.01). No major complications were observed. Two patients (6.25%) required reoperation, and 90.6% of patients expressed satisfaction with the results. Scarring was minimal. In patients with hook-shaped medial canthi, the medial canthal axis was successfully rotated by modifying suture point during the V-Y advancement.</p> Conclusion <p>EC mini-recon can be an intuitive, technically straightforward approach for medial epicanthoplasty revision which maintains the natural canthal angulation while resulting in acceptable scar.</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>