PURPOSE To evaluate the relationship between the incidence of lower eyelid epiblepharon and body mass index in Chinese children and report the outcomes of a rotating suture technique or the L-plasty procedure aimed at correcting the structural anomalies. METHODS The medical records of patients treated surgically, with either rotating suture procedure or L-plasty, for lower eyelid epiblepharon were reviewed retrospectively and compared with an age-matched control group of children without epiblepharon. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters. RESULTS A total of 67 patients (mean age, 5.7 +/- 2.6 years) and 178 controls were included. All patients had coexistent epicanthus. In 62 patients, rotating suture procedures were used; in 5, L-plasty. The BMI in 4- to 6-year-old boys with epiblepharon was significantly higher than that in children without epiblepharon (P = 0.042). All patients showed successful surgical outcomes according to improvement of symptoms and lack of cilia cornea contact. There were no cases of recurrence or other complications. CONCLUSIONS Obesity may be an aggravating factor in cases of lower eyelid epiblepharon, which may be corrected effectively with the rotating suture procedure and the L-plasty procedure. The L-plasty procedure is recommended for patients with coexistent severe epicanthus.