The Influence of Sagittal Head Tilt on Periorbital Appearance: Implications for Clinical Photography and the Evaluation of Postoperative Results

Abstract

Abstract BackgroundConsistency in standardized periorbital photography—specifically, controlling for sagittal head tilt—is challenging yet critical for accurate assessment of preoperative and postoperative images. ObjectivesTo systematically assess differences in topographic measurements and perceived periorbital attractiveness at varying degrees of sagittal head tilt. MethodsStandardized frontal photographs were obtained from 12 female volunteers (mean age 27.5 years) with the Frankfort plane between −15° and +15°. Unilateral periorbital areas were cropped, and topographic measurements were obtained. The images of each individual eye, at varying head tilt, were ranked in order of attractiveness by 11 blinded evaluators. ResultsInter-rater and intra-rater reliability was excellent (intraclass correlation > 0.9). Downward sagittal head tilt was linearly associated with an improved aesthetic rating (Spearman’s correlation; ρ = 0.901, PPPPPP ConclusionsNegative sagittal head tilt significantly improves periorbital aesthetics; however, in the presence of lower eyelid bags, this also increases demarcation of the eyelid cheek junction which may be aesthetically detrimental. Controlling for sagittal head tilt is critical to reliably compare preoperative and postoperative clinical photographs.