Canthal tilt is the angle between the inner corner (medial canthus) and outer corner (lateral canthus) of the eye. If the outer corner sits higher, the tilt is positive; level corners are neutral; a lower outer corner is negative. All three are normal. Changing the tilt itself requires canthoplasty, a specialist procedure usually performed by oculoplastic surgeons, but hooding and heavy lids can often be improved with blepharoplasty.
How canthal tilt is assessed
Imagine a horizontal line through the inner corner of the eye and a second line joining the inner and outer corners. The angle between them is the canthal tilt. In many people the outer corner sits a little higher than the inner corner, giving a mild positive tilt. Measurements taken from photographs are unreliable because head position, camera angle and facial expression all change the apparent angle, so online ‘canthal tilt calculators’ should be viewed with caution.
Positive, neutral and negative tilt
- Positive: the outer corner is higher; often described as giving an alert or ‘upturned’ look.
- Neutral: the corners are roughly level.
- Negative: the outer corner is lower; sometimes perceived as tired or sad, though many people with a negative tilt are considered very attractive.
Canthal tilt has become a popular topic on social media, where it is often exaggerated. It is only one small element of facial appearance, and a balanced face depends far more on overall proportions, skin quality and expression.
Why canthal tilt changes
The outer corner of the eye is held in place by a tendon attached to the bone of the eye socket. With age this tendon and the lower eyelid can loosen, so the outer corner drifts downwards and the lower lid may sag. Descent of the brow and cheek, previous lower-lid surgery, facial nerve weakness and some eye conditions can also alter the tilt. Genetics and ethnic background determine the tilt you are born with.
When to seek medical advice
See your GP or optician if the lower lid pulls away from the eye, if the eye is persistently watery, red or gritty, or if the lid does not close fully. Any sudden change in the position of the eyelids, particularly with facial weakness, double vision or severe headache, needs emergency assessment.
Non-surgical options
Make-up such as winged eyeliner can visually lift the outer corner. Some practitioners use dermal filler at the temple or outer brow, or anti-wrinkle injections to lift the tail of the brow slightly. These effects are subtle and temporary, and they do not alter the position of the canthal tendon. Thread lifts marketed as ‘fox eye’ treatments carry risks and their results are often short-lived; Mr Nassab does not offer thread lifts.
Canthoplasty and canthopexy
Surgery to reposition or tighten the outer corner of the eye (canthoplasty or canthopexy) is delicate work on the eyelid support structures. It is usually performed for functional problems, such as a loose or out-turned lower lid, by oculoplastic surgeons. Purely cosmetic changes to canthal tilt carry risks including an unnatural shape, asymmetry, dry eye and lid malposition. Mr Nassab can advise on referral to an oculoplastic specialist where canthal surgery is being considered.
How blepharoplasty can help
Many people who worry about a negative tilt are actually bothered by hooding of the upper lid or heaviness at the outer corner, which makes the eye look downturned. Upper blepharoplasty removes excess skin and can open up the outer part of the lid. Lower blepharoplasty addresses bags under the eyes. Mr Nassab will examine the lids, brow and lower-lid support to explain what is likely to be achievable. Upper blepharoplasty costs from £5,000 under local anaesthetic (£6,500 general), lower from £7,500 and combined from £9,500. The £150 consultation is separate. Surgery is only for adults aged 18 and over.
Frequently Asked Questions
Is a negative canthal tilt bad?
No. It is a normal variation and not a medical problem. How attractive a face looks depends on many features working together.
Can blepharoplasty change my canthal tilt?
Blepharoplasty does not reposition the corners of the eye, but by removing hooding and heaviness it can make the eyes look less downturned.
Who performs canthoplasty?
Canthoplasty is a specialist procedure usually performed by oculoplastic (eyelid) surgeons. Mr Nassab can discuss eyelid surgery for hooding and bags and advise on referral if canthal surgery is needed.
Can you measure your own canthal tilt?
Photos and apps are unreliable because camera angle and head tilt distort the result. A face-to-face examination is more accurate.
