Background <p>Medial canthi play a crucial role in Chinese facial aesthetics, influencing the perception of eye shape and overall facial attractiveness. However, the aesthetic value of medial canthic folds has often been overlooked.</p> Methods <p>An online survey was conducted from March to May 2024, involving 352 participants from China. Participants rated the attractiveness of 21 images with varying medial canthi coverage and eyelid morphologies. Demographic data, including age, gender, profession, makeup habits, and cosmetic surgery experience, were collected. Multiple linear regression was used to identify factors influencing medial canthi preferences.</p> Results <p>The survey revealed a preference for partially or mostly exposed, horizontally aligned medial canthi. Gender significantly influenced scores for out-fold double eyelids (<i>β</i> = − 0.189, <i>p</i> = 0.013), fully exposed medial canthi (<i>β</i> = − 0.362, <i>p</i> &lt; 0.001), and downward slanting medial canthi (β = − 0.212, <i>p</i> = 0.006). Age impacted all types (<i>p</i> &lt; 0.001), and occupation and cosmetic habits influenced preferences for fully exposed and fully closed medial canthi.</p> Conclusions <p>Different demographic groups prefer mostly and partially exposed horizontal medial canthi. The findings highlight the importance of preserving natural medial canthi characteristics in Chinese facial aesthetics.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>