The eye canthal tilt is the angle between the internal corner of the eyes (medial canthus) and the external corner of the eyes (lateral canthus). This tilt is a crucial section of periorbital aesthetics.
The eye canthal tilt can be negative, neutral, or positive. The canthus tilt is considered positive if the medial canthus angle ranges between 5 and 8 degrees below the lateral canthus. A negative canthal tilt is achieved when the medial canthus tilt varies between -5 to -8 degrees beneath the lateral canthus. A neutral tilt is when the medial canthus and lateral canthus are in line. A positive canthal tilt gives one a more attractive, sharper, and younger look.
According to a study held at the University of Toronto by Bashour & Geist (2007), canthal tilt is a power cue for female facial attractiveness. The possible explanation to this phenomenon as per Bashour & Gest is “The fact that palpebral fissure inclination is steeper in children than adults makes it a neonatal feature, and the fact that it is again steeper in females than males after puberty also makes it a sexually dimorphic feature.”
In their publication “The beautiful eye”, medical doctors Volpe & Ramirez from Johns Hopkins Hospital mentions “In women, the intercanthal axis averages +4.1 mm or +4 degrees. This upward tilt of the intercanthal axis is one of the most distinctive qualities of the beautiful eye. When one looks at any truly beautiful face, this upward tilt is found to be present.”
In the book “Cosmetic Patient Evaluation” by Tian Ran Zhu from Warren Alpert Medical School of Brown University, USA mentions that “The concept of the canthal tilt is critical as it serves as an important indicator of aging. A positive canthal tilt with lower eyelid lightly tilting upward along lateral canthus exudes youth, health, and exuberance. On the contrary, a depressed tilt projects old age, melancholy, and weariness.”
Their findings are widely corroborated by other studies, a positive canthal tilt can make women look “attractive and younger” (Askham et ali, 2019), and “feminized” (Facque et al, 2019). Further to that, the canthal tilt can add a gradually “masculinized appearance” if the tilt depresses with age as the soft tissue descends (Somenek, 2018).
When measuring the canthal tilt, “A positive value designates an upward tilt of the lateral canthus and a negative value a downward tilt. This upward tilt of the intercanthal axis is one of the most distinctive qualities of the beautiful eye” (Volpe & Ramirez, 2005). Bashour & Geist (2007) test this directly in their comprehensive study, they find that a positive canthal tilt adds to the attractiveness of the female face and explain why they think this occurs. The results revealed that female faces with positive canthal tilt are preferred 93 percent of the time.
Bashour, M., & Geist, C. (2007). Is medial canthal tilt a powerful cue for facial attractiveness?. Ophthalmic Plastic & Reconstructive Surgery, 23 (1), 52-56. https://pubmed.ncbi.nlm.nih.gov/17237692/
Volpe, C. R., Ramirez, O. M., (2005). The Beautiful Eye. Facial Plastic, Surgery Clinics of North America. 13 (4), 493–504, https://pubmed.ncbi.nlm.nih.gov/16253836/
Tian Ran Zhu, Ali Banki, Mohammad Banki, Cosmetic Patient Evaluation (2018), In book: Complications in Maxillofacial Cosmetic Surgery https://link.springer.com/chapter/10.1007/978-3-319-58756-1_3
Akşam, E., Karatan, B. (2019). Periorbital Aesthetic Surgery: A Simple Algorithm for the Optimal Youthful Appearance. Plastic and reconstructive surgery. Global Open, 7 (5), e2217. https://pubmed.ncbi.nlm.nih.gov/31333949/
Facque, A. R., Atencio, D., Schechter, L. S., (2019). Anatomical Basis and Surgical Techniques Employed in Facial Feminization and Masculinization. The Journal of Craniofacial Surgery. (30) 5, 1406 – 1408. https://pubmed.ncbi.nlm.nih.gov/31299732/
Somenek, M., (2018). Gender-Related Facial Surgical Goals. Facial Plastic Surgery. 34 (05), 474-479. https://pubmed.ncbi.nlm.nih.gov/30296799/