The term blepharoplasty was coined by Von Graefe in 1817 to describe a reconstructive technique, advocated removal of herniated orbital fat for cosmetic reasons. In 1951, Castenares described the fat compartments of the upper and lower eyelids. Until recently, fat removal had remained an integral part of blepharoplasty. During the last decade, the emphases in technique have shifted to skin removal with conservation of fat and the avoidance of eyelids with an over operated appearance.
Upper eyelid blepharoplasty is usually performed for cosmetic concerns. Functional impairment of vision, or both. Each situation is frequently accompanied by the aging process or secondary to a familial propensity. Lid malposition and ptosis may also be concerns. In most situations, management of the excessive tissue of the upper eyelid includes some consideration of brow position; to ignore the close anatomical relationship between the brow and the upper eyelids in performing surgery of the region potentially jeopardizes the final aesthetic and functional outcomes. The goal is to achieve facial harmony and optional function while maintaining latitude for individual variation.
Because this is elective surgery, it is extremely important that patients are proper candidates for surgery. The patients’ motivations must be sound, they have to be willing to accept imperfection, they have to possess realistic goals, and they have to be willing to accept the prospect of additional surgery. The management of patients with cosmetic eyelid concerns is guided by the careful assessment of the patient, the establishment of a “diagnosis” based on anatomical and aesthetic parameters, and an approach based on sound surgical principles. A thorough evaluation of the patient is therefore necessary, as it would be in any other aspect of medicine and surgery. Both psychological and medical issues should be explored.