Canthal Tilt in Cosmetic Plastic Surgery

Canthal Tilt in Cosmetic Plastic Surgery

Canthal tilt is an important concept in periorbital aesthetics and should be clearly evaluated and discussed before every upper eyelid and lower eyelid procedure. Canthal tilt is defined as the angle between the medial canthus and the lateral canthus. The medial canthus is where the upper eyelids and lower eyelids meet on the nasal side. The lateral canthus is where upper and lower eyelids meet on the ear side. One of the foundations of a youthful periorbital- eyelid aesthetic is having a positive canthal titl between 5-8 degrees.

Types of Canthal Tilt

  • Positive tilt
  • Neutral tilt
  • Negative tilt

Positive tilt refers to where the lateral canthus is 5-8 degrees above the medial canthus. We measure this by drawing an imaginary line between the midpupil portiaon of eyeball. The lateral canthus should be 5-8 degrees higher than the nose side.  The concept of canthal tilt is widely appreciated in the fashion industry. It is a concept that is conserved across gender lines and ethnicity. It is consistently found in youthful and attractive faces.

Neutral canthal tilt is wheren there is no angle between the medial and lateral can thus. This appearance can be well tolerated in men and, often does not connoatate an aged appearance in men. With women, however, this is universally interpreted as a sign of aging. Neutral canthal til also contributes to the tired look that so many women dislke.

Negative canthal tilt is most commonly an advanced sign of aging in both men and women. It is commonly associated with excess upper and lower eyelid skin. It is a strong driver of a tired or sorrowful appearance.

How to Improve your Canthal Tilt

So what causes canthal til to change over time? Like aging itself, diminishing canthal tilt is multifactorial. But, there are a number of things that you can do to maintain your overall periorbatl appearance.

Canthal Tilt Correction

1. Do not smoke. Smoking causes reduced elasticity in every tissue of your body including your lower eyelids. Loss of elasticity leads to laxity in the skin and the supporting structures of your eyelid. To help maintain canthal tilt and periorbital til, avoid smoking.

2. Use Sunscreen. Sun damage is another leading cause of elasticity loss in the soft tissue Always wear appropriate sunscreen.

3. Elastiderm. Use an eye cream that promotes collagen production such as, Elastiderm™.

4. Surgical Correction. A popular procedures is upper eyelid and lower eyelid blepharoplasty. During every preoperative cosmetic plastic surgery consultation, canthal tilt is carefully assessed. At Ocean Drive Plastic Surgery, we aim to correct canthal tilt to withn 5-9 degrees of positivity as this is a cornerstone of periorbital aesthetics. We augment every lower lid blepharoplasty with a procedure called a lateral retincular canthoplasty. This innovative procedure tightens and elevates the lateral canthus allowing us to accurately recreate the positive canthal tilt of your youth and providing for a natural look.


Our  canthoplasty can be utilized on any type of lower eyelid procedure. We commonly complex it with lower eyelid spetal reset procedures in both men and women. As well it is always combined with transconjunctival lower eyelid approaches too. Recreation of positive canthal tilt is a required part of Dr. Durkin’s lower eyelid blepharoplasty procedures. In patients who have preexisting positive tilt, Dr. Durkin supports the existing tilt with a support canthoplasty.  This will maintain canthal tilt over time without distorting your already youthful appearance.  The addition of canthoplasty to lower eyelid procedures does not increase overall recovery time, as this technique is very atraumatic, and the result is very predictable, and natural.

The identification and treatment of canthal tilt when evaluating the lower eyelid is one of many things that separate our practice from the competition.  We lower eyelid is a critical aesthetic and functional subunit of the face, and it must be evaluated and treated comprehensively.  This evaluation must include the concept of canthal tilt to achieve the best possible result.

Positive Canthal Tilt

Model demonstrating positive canthal tilt. Image is copyright protected.

Neutral Canthal Tilt

Example of neutral canthal title. Image is copyright protected.

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