Objective To observe the effect of skin replacement method and Z-plasty on the correction of epicanthus, and to analyze its effect on the appearance of scar. Methods A total of 50 patients with epicanthus treated in our hospital from May 2019 to January 2024 were selected and divided into control group and observation group according to different treatment schemes, with 25 patients in each group. The control group was treated with Z-plasty, and the observation group was treated with skin replacement method. The ocular appearance indexes, scar appearance, patients' satisfaction with postoperative appearance and complications were compared between the two groups. Results The ICD/S of the two groups at 6 months after operation was lower than that before operation, and PFW/S, PFH/S and PFW/ICD were higher than those before operation, the differences were statistically significant (P <0.05); however, there was no significant difference in ICD/S, PFW/S, PFH/S and PFW/ICD between the two groups (P >0.05). The VSS score of the observation group at 1 and 3 months after operation were lower than those of the control group, and the differences were statistically significant (P <0.05). The satisfaction of patients in the observation group was higher than that in the control group, and the difference was statistically significant (P <0.05). After half a year of follow-up, both groups of patients had healed without lacrimal canaliculus injury, incision infection and other complications. Conclusion Both skin replacement method and Z-plasty can achieve better correction effect on epicanthus, which can effectively shorten the distance between inner canthus and increase the length and height of palpebral fissure. However, skin replacement method will not leave obvious scars, and the incision is more beautiful, which is more likely to be recognized by patients.