Blepharoplasty plays a vital role in facial rejuvenation, with direct aesthetic connection to the brow and the cheek. Upper and lower eyelid blepharoplasty may be indicated for the presence of excess skin and/or orbital fat.

Preoperative markings should be made with the patient sitting upright in neutral gaze with the brow properly positioned. The pattern of skin excision should be lenticular in the younger patient and more trapezoid-shaped laterally in the older patient. A skin pinch test can confirm the preoperative
markings. The location and amounts of fat should be determined and marked preoperatively. Skin incisions should be made sharply through the epidermis, with the premarked area of skin resected with fine scissors, scalpel, or a needle-point Bovie. If definition of the supratarsal fold is desired, small strip of orbicularis be resected.Conservative fat excision can be performed as part of an upper lid blepharoplasty for medial fullness. There are two fat compartments, medial and central, that can be accessed through small incisions in the septum, teased out, and resected using pinpoint cautery. Aggressive resection can injure neurovascular structures or extraocular muscles and lead to a “hollowed-out” appearance

The amount of skin to be resected can be estimated with a skin pinch between forceps and usually represents 3 mm of tissue. The technique is approached through a subciliary incision with the skin elevated off the orbicularis to the level of the infraorbital rim. Redundant skin can be removed conservatively and redraped without disturbing the underlying orbicularis.