Objective To investigate the effect of Z-flap plasty in correction of epicanthus. Methods A total of 56 patients with epicanthus admitted to our hospital from January to December 2022 were randomly divided into control group and observation group, with 28 patients in each group. Double eyelid surgery was performed in both groups, and different flap plasty was combined in the same period. The control group was performed with Y-V flap plasty, and the observation group was performed with Z-flap plasty. The clinical effects, incision scar hyperplasia and patient satisfaction were compared between the two groups. Results The excellent and good rate of operation in the observation group was 100.00%, which was higher than 71.43% in the control group (P