The key to a successful outcome in upper eyelid surgery, also known as blepharoplasty, is accurate skin markings. Proper location of where the upper eyelid crease will be placed is crucial. Different racial groups have different eye crease positions. For example, Blacks and Caucasians tend to have a higher eyelid crease than some Asians. This is not an absolute, as there are always exceptions. The crease must be individualized for each person.
In addition to marking the proper location of the eyelid crease, the amount of skin that will be removed also is marked. An overly aggressive upper eyelid skin excision will result in the inability to close the eyelids. Furthermore, in men, it is acceptable to have more skin, giving a "hooded eyelid" appearance. Examples of famous men who have a hooded eyelid include the actors George Clooney and Brad Pitt. Removing too much upper eyelid skin in those who naturally have some amount of hooding will give an unnatural look. In women, a more open eyelid is considered more feminine and allows application of eye shadow if desired.
Proper location of the lower eyelid incision is also important. The lower eyelid incision can be made just under the eyelashes or on the inner aspect of the lower eyelid. If the incision is made on the inner aspect, no scar will be visible. If excess skin and/or excess lower eyelid muscle needs to be addressed, the incision will be on the external aspect of the eyelid, under the eyelashes. If it is lower eyelid bags that need to be addressed, the incision will be on the internal aspect of the eyelid.
Just as with the upper eyelid, removing too much skin of the lower eyelid can create problems. Removing too much lower eyelid skin will cause drooping of the lower eyelid similar to a bassett hound. This causes problems such as dry eye.