Blepharoplasty is one of the most demanding aesthetic procedures, and relevant anatomical knowledge of the eyelid and surrounding area is essential. The pathophysiology of ageing in these sites results in varied clinical features. In upper blepharoplasty, lateral brow lift is a necessary adjunctive procedure. Access through the upper blepharoplasty incision is used to adjust retro-orbicularis oculi fat, for glabellar myotomy, and lateral canthopexy. In lower blepharoplasty, the traditional approach is to use a skin and muscle flap, but skin-only flaps are being reported increasingly. Septal reset and plication of the orbicularis oculi is recommended instead of excision of fat. The aim is improvement of cosmesis with no signs of the procedure.